Mucosal leishmaniasis in an Indian AIDS patient

I describe a similar casefrom India. A 38-year-old man fromthe kala-azar-endemic state of Biharpresented in June, 2003, to the AllIndia Institute of Medical Sciences,New Delhi, for nodular lesions on hischin, oral mucocutaneous junctions,tongue, soft and hard palate, nasalmucosa, and conjuctiva (figure) sinceFebruary, 2003. These nodules had notresponded to antibiotics and topicalsteroid treatment given by localphysicians. The patient was non-alcoholic, non-promiscuous, and hadnot had surgery or bloodtransfusions. He was amarried man with sixchildren. Biopsy samplestaken from the palatalnodule revealed densecellular infiltrates withhistiocytes, lymphocytes,and plasma cells. Noparasite or fungal bodieswere seen on special stains.A pathological diagnosis ofgranuloma infiltrating intothe basal cell layer ofepidermis was made.The past historyrevealed that in March,2003, he had gluteal herpeszoster and hepatomegaly on ultrasonography with consistentleucopenia. In September, 2002, hehad parasitologically proven kala-azarand received 35 injections of sodiumantimony gluconate locally. Thepatient was tested positive for HIV-1and anti-rK-39 antibodies forleishmaniasis. His CD4 count was34/ L and CD8 cells 363/ L. His wife was tested HIV negative. Thepatient was treated successfully with intravenous sodium antimonygluconate and rifampicin for 20 days,and he was also put on highly activeantiretroviral therapy for his HIV co-infection. His lesions disappearedcompletely within 1 month, and hisrepeat CD4 and CD8 cells counts inFebruary, 2004, rose to 233/ L and1289/ L, respectively. He visited lastin June, 2004, for follow-up and wassymptom-free.The eastern states of India areendemic for visceral leishmaniasis andsmall outbreaks of cutaneous leish-maniasis are also reported frequentlyfrom its western states, but until now