Simultaneous Intestinal Leishmaniasis and Mycobacterial Involvement in a Patient With Acquired Immune Deficiency Syndrome

Abstract

Gastrointestinal involvement is reported in approximately 50% to 93% of patients with human immunodeficiency virus. It is frequently the result of coinfection with several microorganisms. Selective Leishmania intestinal involvement presents with atypical symptoms for visceral leishmaniasis, and may appear as a relapse or as the first manifestation of the disease. The authors present a patient with acquired immune deficiency syndrome who has a history of treated leishmaniasis and gastrointestinal infection by showed Mycobacterium avium intracellulare (MAI). After the new onset of abdominal pain, an intestinal biopsy showed the presence of both MAI and Leishmania in duodenum. Intestinal infection by Leishmania must be included in the differential diagnosis in patients with a previous history of leishmaniasis or travel to an endemic area.

Visceral leishmaniasis with duodenal involvement: three immunocompetent cases from southern Iran

“…In the cases described so far, the most common signs and symptoms have been diarrhoea (Laguna et al, 1994;Bechade et al, 1996;Wang et al, 1999;Hofman et al, 2000), abdominal pain (Laguna et al, 1994;Velasco et al, 1998;Wang et al, 1999), fever (Hamour et al, 1998), epigastric pain (Laguna et al, 1994), gastro-intestinal haemorrhage and malabsorption (Sendino et al, 1990). Two of the three cases described here presented with diarrhoea, two were febrile, and all three had unusual blood-cell counts (pancytopenia, thromobocytopenia and/or leucocytosis).…”

“…The intestinal symptoms may be the first manifestation of VL or appear as a relapse (Laguna et al, 1994;Sebastian et al, 1997). Co-infection with HIV appears to increase the risk of intestinal involvement in VL (Datry et al, 1990;Michiels et al, 1992;Jablonowski et al, 1994;Laguna et al, 1994;Bechade et al, 1996;Alonso et al, 1997;Hamour et al, 1998;Velasco et al, 1998;Hofman et al, 2000).…”

Endoscopic appearance of GI mycobacteriosis caused by the Mycobacterium avium complex in a patient with AIDS: case report and review

“…A search of the MEDLINE database (English language publications) identified 54 reported cases of DMAC infection with involvement of the GI tract in patients with AIDS in which an endoscopic description was included. 8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] The demographic, clinical, and endoscopic features, and the outcome for the 55 cases (including the present case) are shown in Table 1. Most reported cases predate the HAART era; only 3 patients received HAART.…”

“…Most reported cases predate the HAART era; only 3 patients received HAART. 8,24 The median age of the patients was 32 years (range 14 months to 50 years). The common presenting symptoms included diarrhea (93%), fever (89%), weight loss (87%), and abdominal pain (82%).…”

“…The CD4 count at presentation was available in only 4 cases; the median CD4 count was 41 cells/mL (6-69 cells/ mL). 8,15,23,24 Most patients died soon after the diagnosis of DMAC infection, despite antimycobacterial therapy. The high mortality rate for patients with GI DMAC infection is probably explained by the fact that only 3 patients received macrolide-containing treatment regimens and HAART.…”