01997nas a2200253   4500000000100000008004100001260001200042653001900054653000800073653002400081653001800105653002600123653003200149100001300181700001700194700001500211700001300226245007600239856026000315300001000575490000800585520113600593022001401729       2026                            d  c06/202610aAmphotericin B10aHIV10aLeishmania infantum10aLeishmaniasis10amolecular diagnostics10aMucocutaneous leishmaniasis1 aNukala N1 aDang-Orita N1 aOpardija A1 aPasula S00aDisseminated mucocutaneous leishmaniasis in a patient with advanced HIV  uhttps://pdf.sciencedirectassets.com/272991/1-s2.0-S1201971226X20033/1-s2.0-S1201971226003279/main.pdf?X-Amz-Security-Token=IQoJb3JpZ2luX2VjEMn%2F%2F%2F%2F%2F%2F%2F%2F%2F%2FwEaCXVzLWVhc3QtMSJHMEUCIQDctNVqTKYdngxGtebGRpPBMXfudsJV0bgxccg6EFtPDgIgQbxgo%2FMySE  a1 - 40 v1673 a<p>We report a 43-year-old male farm worker from El Salvador residing in California's Central Valley who presented with 4 months of progressive upper lip swelling, ulcerative lesions on the nose and left forearm, weight loss, night sweats, headaches, and hoarseness of voice. He had severe HIV-related immunosuppression (CD4 count of 81 cells/mm). Biopsy of a forearm lesion and endobronchial tissue obtained at bronchoscopy revealed intracellular amastigotes consistent with leishmaniasis. Leishmania PCR on endobronchial tissue detected Leishmania donovani/infantum/chagasi complex, and plasma microbial cell-free DNA testing (Karius) confirmed L. infantum. The patient received intravenous liposomal amphotericin B and restarted on antiretroviral therapy; he was discharged to receive induction and maintenance amphotericin B infusions with outpatient HIV clinic follow-up. This case illustrates the diagnostic challenges of disseminated leishmaniasis in severely immunocompromised patients in nonendemic settings and underscores the importance of early recognition and a tiered diagnostic approach in high-risk populations.</p>  a1878-3511