title: Development of visceral leishmaniasis in an HIV(+) patient upon immune reconstitution following the initiation of antiretroviral therapy.
abstract: METHODS
  Here, we report on a case of VL in an HIV-infected patient from the Republic of Georgia who had moved to Germany 14 years before and who had travelled several times to southern Europe in between. After presenting with typical Pneumocystis jiroveci pneumonia, which was treated appropriately, the patient was started on antiretroviral therapy. Shortly thereafter, however, he developed fever of unknown origin. All laboratory assays for the diagnosis of various infectious agents including serological assays and polymerase chain reaction testing of bone marrow aspirate to diagnose VL did not yield positive results at first. Only upon repetition of these tests, diagnosis of VL could be made and the patient treated accordingly.
  
  
  METHODS
  Visceral leishmaniasis (VL) is a common opportunistic infection in HIV-positive patients from endemic countries but occurs rarely following antiretroviral treatment. This case demonstrates that patients who develop VL upon immune reconstitution may not be diagnosed initially by standard laboratory assays for the diagnosis of VL and underlines the necessity to repeat serologic and molecular biologic testing for VL in cases of fever of unknown origin in patients from or with travel history to endemic countries.
authors.affiliation: Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07740, Jena, Thuringia, Germany. benjamin.schleenvoigt@med.uni-jena.de.
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Schleenvoigt
authors.affiliation: Institute of Tropical Medicine and International Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Ignatius
authors.affiliation: Institute for Medical Microbiology, Jena University Hospital, Jena, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Baier
authors.affiliation: Department of Internal Medicine - Gastroenterology, Infectious Diseases, and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schneider
authors.affiliation: Department of Internal Medicine IV, Jena University Hospital, Jena, Germany.
authors.forename: Marko
authors.initials: M
authors.lastname: Weber
authors.affiliation: Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07740, Jena, Thuringia, Germany.|Department of Internal Medicine IV, Jena University Hospital, Jena, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Hagel
authors.affiliation: Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07740, Jena, Thuringia, Germany.|Department of Medicine I, Medical University of Vienna, Vienna, Austria.
authors.forename: Christina
authors.initials: C
authors.lastname: Forstner
authors.affiliation: Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, 07740, Jena, Thuringia, Germany.
authors.forename: Mathias W
authors.initials: MW
authors.lastname: Pletz
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005846:Georgia (Republic); D005858:Germany; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy*; D006801:Humans; D054019:Immune Reconstitution Inflammatory Syndrome / Q000175:diagnosis*; D007898:Leishmaniasis, Visceral / Q000175:diagnosis*; D008297:Male; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000188:drug therapy
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV infection; IRIS; Immune reconstitution inflammatory syndrome; Visceral leishmaniasis