Coinfection of Leishmania guyanensis and Human Immunodeficiency Virus-Acquired Immune Deficiency Syndrome: Report of a Case of Disseminated Cutaneous Leishmaniasis in Ecuador

Abstract

AbstractReported herein is the first case of Leishmania-human immunodeficiency virus (HIV) coinfection in Ecuador. In Ecuador, HIV infections overlap endemic areas of leishmaniasis. Immunosuppression is a well-established risk factor for developing severe disease. This is a severe case of a 32-year-old man presenting with disseminated pleomorphic ulcers, papules, and cutaneous plaque-like lesions over his whole body. Numerous amastigotes were observed in both skin scrapings and biopsies. The sequence of the cytochrome b gene confirmed the presence of Leishmania guyanensis. The patient was treated but failed to respond to meglumine antimoniate and amphotericin B. Six months later, the patient died due to bacterial septic shock.

Figure 1.

Erythematous, nonpainful, circumscribed, elevated plaque-like lesions with well-delineated borders located in the patient's upper limbs and hands.

Figure 2.

Erythematous violaceous ulcerative lesions of different sizes with uneven borders covered with bloody purulent scabs located in the patient's lower limbs.

Figure 3.

Multiple elevated plaque-like lesions with active borders, some confluent and others as satellite papules scattered throughout the patient's abdomen.

Figure 4.

Histopathology of a lesion from the patient's abdomen showing a massive inflammatory infiltrate with many leukocytes, neutrophils, lymphocytes, as well as a large number of macrophages infected with numerous Leishmania amastigotes.

Figure 5.

Phylogenetic tree of cytochrome b gene sequences from Leishmania species. The leishmanial cyt b genes were amplified from a cutaneous lesion of the patient (sample 8). Phylogenetic tree analysis with sequences obtained from the patient as well as those from 13 Leishmania spp. references strains was performed. Scale bar indicates 0.01% divergence.