A 49-year-old male patient was admitted in October 2014 for abdominal pain and diarrhea.
Personal history of HIV infection stage C3 diagnosed in 2005 and chronic HCV infection with data and portal hypertension.
Severe smoker to date and drinker of 100 g daily alcohol until 2013.
Treatment with lamivudine-abacavir-lopinavir-ritonavir antiretrovirals (3TC + ABC + LPV + RTV), with poor compliance.
In the days prior to admission she had colic-like abdominal pain accompanied by 7-8 daily diarrheal stools without pathological products, with fever thermometered up to 38 °C and deterioration of general status.
The physical examination showed a regular general condition, highlighting an extensive hyperpigmented lesion at the level of the trunk in the form of confluent plaques, along with moderate stenosis of the trunk in both hands, hepatomegaly of 6 cm and
Blood tests revealed only Hb 11.4 g/dl, 3000/μl leukocytes and 92,000/μl platelets, GGT 119 U/L, FA 122 U/L, hepatic ultrasound showed enlarged liver.
The clinical condition of the patient is admitted, starting treatment with serum therapy, absolute diet and restarting antiretroviral treatment with tenofovir-emtricitabine-raltegravir (TDF-FTC-RAL).
A new analytical highlighted CD4 44 cells/mm3 and HIV viral load 80,000 copies/mL, without resistance to antiretroviral drugs.
CMV viral load was negative.
Coprocultive agent and negative feces, with negative Clostridium difficile toxin.
Urocultive and hemocultive negative.
The patient developed acute renal failure by tenofovir, which was switched to abacavir, with good outcome.
Homogeneous CT scan of the pelvis showed hepatomegaly with a spleen of 18 cm and small lymph nodes at the thoracic and abdominal levels.
Bronchoscopy revealed diffuse inflammatory signs predominantly in the left bronchial tree, with absence of bronchiectasis cells and negative AFB.
Leishmania parasites that correspond to cecum did not reveal lesions were taken several biopsies at random at the level of ileum, cecum and colon, whose pathology report refers mucosa of ileum and large intestine with numerous intracellular microorganisms
A skin biopsy of the trunk and back of the hands was performed, resulting in leishmaniasis.
These findings, compatible with visceral and cutaneous leishmaniasis, began treatment with liposomal amphotericin B at a dose of 5 mg/kg/day for 5 days, disappearing diarrhea and fever and good oral.
Subsequently, in the Day Hospital, he has followed the consolidation phase of the treatment, receiving 200 mg IV on days 10, 17, 24, 31 and 38, with good clinical and analytical response to the present time.
