title: [Uncommon cutaneous presentation of visceral Leishmaniasis associated with HIV].
abstract: BACKGROUND
  Visceral leishmaniasis is not normally expressed in skin. Herein, we describe the case of an HIV-positive patient who developed two unusual skin manifestations during an episode of visceral leishmaniasis.
  
  
  METHODS
  A 48-year-old female patient consulted initially for infiltrated purpura of all four limbs. Skin biopsy revealed leukocytoclastic vasculitis with Leishman-Donovan bodies. Laboratory tests showed medullary, splenic, gastric and colic involvement, suggesting systemic disease, and enabling visceral leishmaniasis to be diagnosed. Two years later, despite prolonged treatment, the patient presented maculopapular exanthema, and histology revealed persistent Leishman-Donovan bodies.
  
  
  CONCLUSIONS
  We report herein an association of two rare skin manifestations in an HIV-positive patient with visceral leishmaniasis: infiltrated purpura and maculopapular exanthema. However, the underlying mechanisms remain hypothetical. The initial leukocytoclastic exanthema could be secondary to either polyclonal hypergammaglobulinaemia or to IgA deposits, or possibly to mechanical impairment of blood vessels by the actual parasite. The maculopapular exanthema occurring later raised the possibility of post-Kala-Azar leishmaniasis due to blood-borne dissemination in an anergic subject or perhaps even immune reconstitution inflammatory syndrome.
authors.affiliation: Service de maladies infectieuses et tropicales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France; Service de dermatologie, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France. Electronic address: christopher.cossart@yahoo.fr.
authors.forename: C
authors.initials: C
authors.lastname: Cossart
authors.affiliation: Service de maladies infectieuses et tropicales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
authors.forename: G
authors.initials: G
authors.lastname: Le Moal
authors.affiliation: Service de maladies infectieuses et tropicales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
authors.forename: M
authors.initials: M
authors.lastname: Garcia
authors.affiliation: Service d'anatomie et de cytologie pathologiques, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
authors.forename: E
authors.initials: E
authors.lastname: Frouin
authors.affiliation: Service de dermatologie, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
authors.forename: E
authors.initials: E
authors.lastname: Hainaut-Wierzbicka
authors.affiliation: Service de maladies infectieuses et tropicales, CHU de Poitiers, 2, rue de la Milétrie, 86021 Poitiers, France.
authors.forename: F
authors.initials: F
authors.lastname: Roblot
mesh_terms: D001706:Biopsy; D005076:Exanthema / Q000209:etiology*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000150:complications / Q000175:diagnosis*; D008875:Middle Aged; D011693:Purpura / Q000209:etiology*; D012867:Skin / Q000473:pathology
keywords: Exanthème maculopapuleux; HIV; Leishmaniasis; Leishmaniose; Leukocytoclastic vasculitis; Maculopapular exanthema; Purpura; VIH; Vascularite leucocytoclasique