146 A Rare Case of Gastric Leishmaniasis in an Immunocompromised Patient

Introduction/Objective Leishmaniasis is caused by protozoal parasites and typically presents as cutaneous, mucocutaneous, or visceral disease. Visceral leishmaniasis commonly involves the liver, spleen, and bone marrow. However, gastric involvement is rare and only a few cases documented in the literature. Methods/Case Report A 45-year-old male with AIDS and a history of neurosyphilis, histoplasmosis, strongyloidiasis, and prior visceral leishmaniasis presented with pancytopenia. Due to low vitamin B12 levels and elevated intrinsic factor antibodies, endoscopy was performed to evaluate for atrophic gastritis. Patchy atrophic mucosa was seen, and gastric mapping biopsies were obtained. Histologic examination showed active chronic gastritis with abundant Helicobacter pylori. In addition, numerous intracellular amastigotes consistent with Leishmania spp. were identified within macrophages in the lamina propria. Bone marrow biopsy confirmed recurrent visceral leishmaniasis. PCR analysis identified the organism as Leishmania donovani/infantum/chagasi. Special stains and immunohistochemistry for other infectious organisms were negative. Results NA Conclusion This case highlights rare gastric involvement by visceral leishmaniasis and underscores the need for high clinical suspicion for multiple concurrent infections in immunocompromised patients. Careful histologic examination, including routine H&E evaluation, is critical, especially in the absence of specific stains for certain organisms like Leishmania.