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Atypical Lesions as a Sign of Cutaneous Dissemination of Visceral Leishmaniasis in a Human Immunodeficiency Virus–Positive Patient Simultaneously Infected by Two Viscerotropic Leishmania Species

Joanna R. Santos-OliveiraLaboratório Interdisciplinar de Pesquisas Médicas, Laboratório de Pesquisa em Leishmaniose, Laboratório de AIDS e Imunologia Molecular, e Instituto de Pesquisa Clínica Evandro Chagas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil; Secretaria Municipal de Saúde de Cabo Frio, Brazil; Institute of Microbiology and Hygiene, Charité University Medicine Berlin, Berlin, Germany

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Alda M. Da-CruzLaboratório Interdisciplinar de Pesquisas Médicas, Laboratório de Pesquisa em Leishmaniose, Laboratório de AIDS e Imunologia Molecular, e Instituto de Pesquisa Clínica Evandro Chagas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil; Secretaria Municipal de Saúde de Cabo Frio, Brazil; Institute of Microbiology and Hygiene, Charité University Medicine Berlin, Berlin, Germany

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Lucy H. S. PiresLaboratório Interdisciplinar de Pesquisas Médicas, Laboratório de Pesquisa em Leishmaniose, Laboratório de AIDS e Imunologia Molecular, e Instituto de Pesquisa Clínica Evandro Chagas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil; Secretaria Municipal de Saúde de Cabo Frio, Brazil; Institute of Microbiology and Hygiene, Charité University Medicine Berlin, Berlin, Germany

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Elisa CupolilloLaboratório Interdisciplinar de Pesquisas Médicas, Laboratório de Pesquisa em Leishmaniose, Laboratório de AIDS e Imunologia Molecular, e Instituto de Pesquisa Clínica Evandro Chagas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil; Secretaria Municipal de Saúde de Cabo Frio, Brazil; Institute of Microbiology and Hygiene, Charité University Medicine Berlin, Berlin, Germany

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Katrin KuhlsLaboratório Interdisciplinar de Pesquisas Médicas, Laboratório de Pesquisa em Leishmaniose, Laboratório de AIDS e Imunologia Molecular, e Instituto de Pesquisa Clínica Evandro Chagas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil; Secretaria Municipal de Saúde de Cabo Frio, Brazil; Institute of Microbiology and Hygiene, Charité University Medicine Berlin, Berlin, Germany

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Carmem B. W. Giacoia-GrippLaboratório Interdisciplinar de Pesquisas Médicas, Laboratório de Pesquisa em Leishmaniose, Laboratório de AIDS e Imunologia Molecular, e Instituto de Pesquisa Clínica Evandro Chagas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil; Secretaria Municipal de Saúde de Cabo Frio, Brazil; Institute of Microbiology and Hygiene, Charité University Medicine Berlin, Berlin, Germany

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Manoel P. Oliveira-NetoLaboratório Interdisciplinar de Pesquisas Médicas, Laboratório de Pesquisa em Leishmaniose, Laboratório de AIDS e Imunologia Molecular, e Instituto de Pesquisa Clínica Evandro Chagas, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil; Secretaria Municipal de Saúde de Cabo Frio, Brazil; Institute of Microbiology and Hygiene, Charité University Medicine Berlin, Berlin, Germany

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Leishmaniasis is considered an emerging opportunistic disease in human immunodeficiency virus (HIV)–infected patients who have considerably variable clinical presentation. We report a patient with visceral leishmaniasis who had unexpected clinical aspects (atypical cutaneous lesions appearing after long-term evidence of visceral parasites). The patient had hepatoesplenomegaly in the absence of fever, but was otherwise generally healthy. The HIV viral load was low despite severe immunossupression (low lymphocyte proliferation and low level of interferon-γ, concomitant with a high lymphocyte activation status). Surprisingly, two Leishmania strains were isolated from his bone marrow (typical L. infantum sequence MON-1, type A) and skin (L. donovani MON-2 sequence); this second strain had not been previously identified in Brazil. The association of visceral leishmaniasis and HIV/acquired immunodeficiency syndrome is a largely unknown disease, particularly in areas in which leishmaniasis is not endemic. Such atypical cases indicate that this disease can be undiagnosed in clinical settings.

Author Notes

*Address correspondence to Manoel P. Oliveira-Neto, Instituto de Pesquisa Clínica Evandro Chagas, Instituto Oswaldo Cruz, FIOCRUZ, Av. Brasil 4365, Manguinhos, Rio de Janeiro, Brazil. E-mail: manoel.paes@ipec.fiocruz.br

Financial support: This study was supported by Programa Nacional de DST/AIDS, Ministério da Saúde (grant ED00095/2007); Instituto de Pesquisa Clínica Evandro Chagas; Instituto Oswaldo Cruz/FIOCRUZ (internal funds); Fundação de Amparo a Pesquisa do Estado do Rio de Janeiro; Conselho Nacional de Desenvolvimento Científico e Tecnológico; and the European Union (LeishEpinetSA, INCO-CT2005-015407). Joanna R. Santos-Oliveira was supported by a fellowship from the Conselho Nacional de Desenvolvimento Científico e Tecnológico. Alda M. Da-Cruz and Elisa Cupolillo were supported by fellowships from Fundação de Amparo a Pesquisa do Estado do Rio de Janeiro and Conselho Nacional de Desenvolvimento Científico e Tecnológico.

Disclosure: None of the authors have any potential financial conflicts of interest.

Authors' addresses: Joanna R. Santos-Oliveira, Alda M. Da-Cruz, Elisa Cupolillo, and Carmem B. W. Giacoia-Gripp, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil, E-mails: joannars@ioc.fiocruz.br, alda@ioc.fiocruz.br, ecupolillo@ioc.fiocruz.br, and carmembg@ioc.fiocruz.br. Lucy H. S. Pires, Secretaria Municipal de Saúde de Cabo Frio, São Cristovão, Cabo Frio, Brazil, E-mail: lucypires@ig.com.br. Katrin Kuhls, Institute of Microbiology and Hygiene, Charité University Medicine Berlin, Berlin, Germany, E-mail: katrin.kuhls@o2online.de. Manoel P. Oliveira-Neto, Instituto de Pesquisa Clínica Evandro Chagas, FIOCRUZ, Rio de Janeiro, Brazil, E-mail: manoel.paes@ipec.fiocruz.br.

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