DBE may be critical in the management of MSBT providing additional information that may be decisive in the clinical course of these patients.

Emergency DBE is feasible, safe and effective in acute OGIB and may avoid major surgery, diagnosing and successfully treating most patients. Combined approach with RT viewing by CE is especially useful to identify recurrent bleeding vascular lesions such as DL that may be easily misdiagnosed by non-emergency DBE.

We report the case of a 31-year-old male who was diagnosed with HIV infection eleven years ago. At this moment his disease is in stage C3. He consulted because of watery diarrhea with no pathologic products for the last 5 months. He also reported continual abdominal pain unrelated to food ingestion. Over those months he lost about 7-8 kg of body weight, and some skin nodes developed in different parts of his body. Laboratory parameters were nonspecific in the first study. Antibodies against Leishmania, CMV, syphilis, HBV, and HCV were all negative. Blood and stool cultures and parasite tests were all negative, too. A biopsy was obtained from skin nodes, which was positive for Leishmania, and a digestive endoscopy was carried out, which showed a paved, nodular mucosa all over the duodenum, from which we took several biopsies (Figs. 1 and 2). A histological study revealed a clear, severe infiltration of duodenal villi by macrophages filled with Leishmania bodies (Fig. 3). Diagnosis: malabsorption due to visceral leishmaniasis with skin and small-bowel infiltration in a HIV patient. DISCUSSION Leishmaniasis is a parasitic disease transmitted by the biting of Phlebotomus, a kind of mosquito, and caused by different species of Leishmania. There are three forms of presentation: skin nodes (caused by Leishmania tropica), mucocuta

In our region patients with WD are diagnosed at a younger age, and in most cases for hepatic disease. Patients with neurological disease or liver cirrhosis had a high level of free copper not associated to ceruloplasmin and cupruria. The disease had a favorable evolution in all patients but those diagnosed with hepatic disease or advanced neurological disease.

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