First reported cases of diffuse cutaneous leishmaniasis in human immunodeficiency virus positive patients in Jaipur District of Rajasthan, India
This was a case report of a 50-year-old male agriculturist, diagnosed as HIV positive 1½ years back on antiretroviral therapy (ART), who presented with a 6 month history of asymptomatic skin lesions over his limbs. Physical examination revealed multiple, diffuse, non-ulcerating, papulonodular and non-itchy skin lesions of size 2-18 mm []. History revealed that the lesions first appeared on the feet and then over the hands. There was no history of travel to endemic areas of leishmaniasis. There was no hepatosplenomegaly and lymphadenopathy. The laboratory investigations revealed anemia hemoglobin (Hb - 8.3 g/dL). The liver function tests, renal function tests, lipid profile and blood sugar were within the normal limits. The platelet count was 2 lacs/μL and the total leucocyte count was 5,100/μL.\nChest X-ray and ultrasound of abdomen were normal. His CD4 count was 126 cells/μL and HIV viral load was <47 copies/mL. The patient was initially suspected to be having histoplasmosis, which was ruled out by skin biopsy.\nPunch biopsy of skin lesions showed 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 a day and 450 mg rifampicin daily for 1 month along with ART (nevirapine, stavudine and lamivudine). The patient improved on treatment but later was lost to follow-up.