A 42-year-old male, diagnosed with HIV infection eight years ago, with regular immunological controls, without criteria for initiation of antiretroviral treatment.
He had a history of cutaneous leishmaniasis in the right forearm 20 years ago, when it was diagnosed in Madre de Dios (Eastern Amazon of Peru).
He said he had received incomplete treatment, which he could not specify.
He had also undergone right ear cholesteatoma 10 years ago, with right peripheral facial paralysis as a sequel.
She had no history of other diseases.
There were annual clinical controls of viral load (CV) and CD4 T lymphocyte levels, remaining in stable values (CV < 20,000 copies/ml and CD4 > 700 cells/mm3), up to 37.466 CD4 count.
During this period she had intercurrent episodes of diarrhea and self-limiting runny nose.
There were also positive markers for hepatitis B: HBsAg and total anticore, with no alteration in liver function tests.
He came to control in the Infectious Diseases Department complaining of parietal headache and persistent nasal congestion, without lesions in the nailing examination.
One month later she presented epistaxis, mucopurulent nasal secretion and a tumor was observed in the right nasal fossa (nasal wing).
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The examination showed papuloulcerative lesions of approximately 0.5 cm in diameter in the vestibular and mucosal region of the right nasal fossa, presence of mucopurulent secretion and an exophytic mass.
A biopsy of the nasal tumor was performed for study.
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Physical examination also revealed a depressed scar, thin edge, hypopigmented, irregular leishmaniasis, 2 cm in diameter in the right forearm, corresponding to an old skin lesion.
Highly active antiretroviral therapy (HAART) was initiated with zidovudine, lamivudine, ritonavir, due to the appearance of symptoms and suspicion of HIV-related neoplasia.
The histological study showed oval structures, 2 to 4 μm in diameter, uniform in size, with a peripheral kinetoplast located in the cytoplasm of histiocytes, compatible with Leishmania spp.
Indirect immunofluorescence (IIF) (with total antigen for L. bovis and L. brasiliensis) detected anti-Leishmania antibodies at 1 dilution, confirming the diagnosis of meningitis.
One month after starting HAART, stibogluconate sodium 20 mg/kg/day was started for 30 days.
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After completing the treatment with sodium stibogluconate, the evolution was favorable and the lesion improved between two and four weeks, until complete healing.
Three months later, CD4 values increased to 843 cells/ml and viral load decreased to < 40 copies/ml.
Currently the patient is asymptomatic, with a GA lesion, without relapse of the disease or similar lesions.
