title: Presence of Leishmania organisms in specific and non-specific skin lesions in HIV-infected individuals with visceral leishmaniasis.
abstract: BACKGROUND
  Leishmania coinfection is frequently seen in human immunodeficiency virus (HIV)-infected patients in endemic areas, and from time to time the protozoan is detected in cutaneous biopsies.
  
  
  OBJECTIVE
  To establish the characteristics and possible ethiologic role of the presence of Leishmania in these lesions.
  
  
  METHODS
  We studied 12 cutaneous biopsies with Leishmania organisms from nine HIV-infected patients (seven men and two women) with visceral leishmaniasis, diagnosed by bone marrow examination, seen over a period of 9 years.
  
  
  RESULTS
  Based on clinical characteristics, evolution and response to anti-leishmanial treatment, cutaneous alterations were found to be related to the presence of the protozoan in six cases, whereas in the other six cases it was not considered responsible for the dermatological lesions (dermatofibroma, and lesions of psoriasis, Reiter's syndrome, bacillary angiomatosis, cryptococcosis and oral aphthae). Of note was the high prevalence of specific mucocutaneous manifestations, usually accompanied by intense pruritus, great variability, and a tendency to relapse after treatment stopped. On two occasions, detection of the protozoa in skin biopsies led to the diagnosis of a previously unsuspected visceral leishmaniasis.
  
  
  CONCLUSIONS
  Cutaneous detection of Leishmania is frequent in HIV-infected individuals with visceral leishmaniasis. Sometimes Leishmania is associated with changes attributable to other dermatological processes, and its presence does not imply a causative role. A clear relationship between the systemic process and the therapeutic response is necessary to demonstrate an ethiologic role.
authors.affiliation: Department of Dermatology, University Hospital, School of Medicine, Malaga, Spain. dermafac@uma.es
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Bosch
authors.forename: Ana B
authors.initials: AB
authors.lastname: Rodrigo
authors.forename: Purificación
authors.initials: P
authors.lastname: Sánchez
authors.forename: María V
authors.initials: MV
authors.lastname: de Gálvez
authors.forename: Enrique
authors.initials: E
authors.lastname: Herrera
mesh_terms: D000328:Adult; D000818:Animals; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000469:parasitology* / Q000473:pathology*; D006801:Humans; D007891:Leishmania / Q000302:isolation & purification*; D007898:Leishmaniasis, Visceral / Q000209:etiology / Q000469:parasitology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D012871:Skin Diseases / Q000209:etiology / Q000469:parasitology* / Q000473:pathology*