title: Coinfection of visceral leishmaniasis and Mycobacterium in a patient with acquired immunodeficiency syndrome.
abstract: We report a case of coinfection of visceral leishmaniasis and Mycobacterium avium-intracellulare in the same lesions in the small bowel and bone marrow of a 33-year-old man with acquired immunodeficiency syndrome who complained of abdominal pain and chronic diarrhea. The duodenal mucosa and bone marrow biopsy specimens showed numerous foamy macrophages packed with two forms of microorganisms that were identified histologically and ultrastructurally as Leishmania and Mycobacterium species. Visceral leishmaniasis is rarely suspected in patients residing in nonendemic countries including the United States. It should be included in the differential diagnosis for opportunistic infection in patients with acquired immunodeficiency syndrome. An appropriate travel history is important. To our knowledge, this is the first reported case showing coinfection of visceral leishmaniasis and Mycobacterium avium-intracelluulare in the same lesion in a patient with acquired immunodeficiency syndrome.
authors.affiliation: Department of Pathology, Harbor-UCLA Medical Center, University of California Los Angeles, Torrance, CA 90509, USA.
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.forename: C
authors.initials: C
authors.lastname: Vanley
authors.forename: E
authors.initials: E
authors.lastname: Miyamoto
authors.forename: J A
authors.initials: JA
authors.lastname: Turner
authors.forename: S K
authors.initials: SK
authors.lastname: Peng
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000382:microbiology / Q000469:parasitology; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D000818:Animals; D001706:Biopsy; D001853:Bone Marrow / Q000382:microbiology / Q000469:parasitology / Q000473:pathology; D006801:Humans; D007413:Intestinal Mucosa / Q000382:microbiology / Q000469:parasitology / Q000473:pathology / Q000648:ultrastructure; D007421:Intestine, Small / Q000382:microbiology / Q000469:parasitology / Q000473:pathology / Q000648:ultrastructure; D007898:Leishmaniasis, Visceral / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D008264:Macrophages / Q000382:microbiology / Q000469:parasitology / Q000648:ultrastructure; D008297:Male; D008854:Microscopy, Electron; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications / Q000175:diagnosis* / Q000473:pathology