First reported cases of diffuse cutaneous leishmaniasis in human immunodeficiency virus positive patients in Jaipur District of Rajasthan, India
This was a second case of a 43-year-old male laborer, diagnosed as HIV positive 2 years back who was on ART and anti-tubercular treatment for the past 9 months. He presented with a 7 month history of asymptomatic skin lesions all over his body. Physical examination revealed multiple bilateral asymmetrical diffuse, papulonodular, non-itchy skin lesions of size 2-25 mm on the face, trunk and extremities. Lesions first appeared on the arm and progressively spread to involve the face, legs and trunk []. There were no signs of ulceration and scarring. There was no lymphadenopathy and hepatosplenomegaly. There was no history of travel to endemic areas of leishmaniasis. The patient was initially suspected to be suffering from histoplasmosis, but skin biopsy taken from the nodules ruled it out. Laboratory investigations revealed anemia (Hb-9.1 g/dL). Liver function tests, renal function tests and lipid profile were normal. Ultrasonography of the abdomen was normal. His CD4 count was 50 cells/μL and HIV viral load was 1750 copies/mL. Punch biopsy of skin lesions revealed sheets of histiocytic cells in the sub epithelial tissue, stuffed with numerous amastigotes of Leishmania. Mild lymphocytic and plasma cell infiltrate was also noted [].\nThe patient was treated with ketoconazole 200 mg twice daily and 450 mg rifampicin daily for 1 month along with ART (nevirapine, stavudine and lamivudine). The patient initially responded to treatment but later on expired due to chest infection.