Concomitant Disseminated Cutaneous and Visceral Leishmaniasis in a Person Living With Hiv: A Case Report

Leishmaniasis is considered the third most common parasitic infection affecting people living with the human immunodeficiency virus (PLHIV), and it may present in visceral, cutaneous, or mucocutaneous forms. Diagnosis is often challenging, given its ability to mimic other infectious or malignant diseases. This report presents a rare case of coinfection with both disseminated cutaneous and visceral leishmaniasis in a PLHIV. A 43-year-old male patient reported that, since November 2022, he had noticed the development of hyperchromic macules on his left hand, being diagnosed with cutaneous leishmaniasis and treated with meglumine antimoniate (Glucantime®) for 25 days, achieving initial clinical remission. In 2023, he was diagnosed as HIV-positive and simultaneously presented worsening of his dermatologic condition, with dissemination of lesions to the trunk, lower and upper limbs, and the appearance of painful ulcers. During hospitalization, a skin biopsy was performed to investigate possible differential diagnoses, including Kaposi's sarcoma; however, the patient was discharged for outpatient follow-up, which he did not continue. Regularly using ART since June 2023, already on a simplified regimen, with undetectable viral load and a CD4 count of 50 cells/mm³, the patient returned to the Infectious Diseases service in 2025. On examination, he presented thin, violaceous-brownish macules and plaques, slightly infiltrated, disseminated, and without inflammatory signs. Due to a complete blood count showing severe pancytopenia and moderate splenomegaly on abdominal ultrasound, a bone marrow aspirate was performed, confirming visceral leishmaniasis through the presence of amastigotes. Simultaneously, a new skin biopsy revealed disseminated cutaneous leishmaniasis. The patient was hospitalized and received antimicrobial therapy with liposomal amphotericin B, 200 mg/day for ten days (total dose: 2,000 mg), with good clinical and laboratory response. Coinfection with leishmaniasis and HIV is a condition of high morbidity and great clinical complexity. Although the coexistence of HIV and visceral leishmaniasis is well documented, particularly in endemic regions, the triple association involving the cutaneous form represents a diagnostic challenge. In this case, once the diagnosis was established and with appropriate treatment, prophylaxis, and post-discharge follow-up, complete recovery was achieved without complications.