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.
BT - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases C1 - https://www.ncbi.nlm.nih.gov/pubmed/41946443 DA - 06/2026 DO - 10.1016/j.ijid.2026.108692 J2 - Int J Infect Dis LA - ENG M3 - Article N2 -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.
PY - 2026 SP - 1 EP - 4 T2 - International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases TI - Disseminated mucocutaneous leishmaniasis in a patient with advanced HIV UR - https://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 VL - 167 SN - 1878-3511 ER -