A 39-year-old HIV-positive patient, category C3, presented to the emergency department of our hospital with abdominal pain.
He had bilateral cervical adenopathies due to Mycobacterium infection, of which he was under treatment.
Abdominal pain had started eight hours before in the epigastrium and was later located in the right iliac fossa.
Physical examination revealed mild abdominal disfunction with signs of peritoneal irritation.
The only alteration found in the blood analysis was a mild leukocytosis (11.70 x 103/mL) with neutrophilia (78%).
Bilirubin, amylase, and liver enzymes were normal.
Abdominal ultrasound showed hepatomegaly, stenosis and peripancreatic, paraaortic and celiac adenopathies.
The appendix and free peritoneal fluid were not visualized.
The patient was operated on with the clinical diagnosis of acute colitis.
At the surgical exploration, the appendix was macroscopically normal, no lymphadenopathy was observed, and a cystectomy was performed.
The immediate postoperative period was uneventful and the patient was discharged 48 hours later.
Histopathological examination of the specimen showed the presence of leishmania in the appendix and in two mesoappendix ganglia.
With this result, medical treatment of Leishmaniasis was initiated.
