Visceral leishmaniasis with mediastinal lymphadenopathy diagnosed with endoscopic ultrasound-guided fine needle aspiration

Area of Science:

• Neuroimmunology
• Infectious Diseases
• Oncology

Background:

• Advanced HIV infection with severe CD4 lymphopenia (<100/mm3) poses significant risks for opportunistic infections and malignancies.
• A history of visceral leishmaniasis (VL) in immunocompromised patients can indicate a potential for reactivation or atypical presentations.

Observation:

• A 44-year-old male patient with HIV and prior VL presented with a 3-month history of progressive bilateral leg weakness and paresthesia.
• Clinical presentation suggested a neurological complication, prompting further diagnostic investigation.

Findings:

• Imaging studies revealed significant leptomeningeal thickening, indicative of inflammation or infiltration of the brain and spinal cord linings.
• Enlargement of hilar and mediastinal lymph nodes was observed, suggesting a systemic process, potentially infectious or neoplastic.

Implications:

• The findings highlight the complex interplay between HIV, opportunistic infections like VL, and potential neurological complications.
• Leptomeningeal thickening and lymphadenopathy in this context warrant thorough investigation to determine the exact etiology, which could range from opportunistic infections to lymphoproliferative disorders.
• Early diagnosis and targeted treatment are crucial for managing neurological deficits and improving outcomes in advanced HIV patients.