title: An unusual presentation of leishmaniasis in a human immunodeficiency virus-positive individual.
abstract: BACKGROUND
  Leishmaniasis is a neglected tropical disease caused by vector-borne protozoa of the genusLeishmania. Cutaneous and mucocutaneous forms result in disfiguration or mutilation, whilst visceral leishmaniasis (VL) affects multiple organs and is fatal if untreated. Notably,Leishmaniaare capable of establishing a chronic infection, which may reactivate years after initial infection when the host becomes immune-suppressed.
  
  
  METHODS
  A 24-year-old human immunodeficiency virus (HIV)-positive male presented for excision of anal condylomas. At the time of his current condyloma excision, the patient had no additional symptoms or cutaneous findings, but was noted to have been only intermittently compliant with his antiretroviral therapy. Microscopic examination of the haematoxylin and eosin-stained anal condyloma tissue revealed koilocytic change, ulceration and brisk histiocytic inflammation containing numerous small intracellular bodies suggestive ofLeishmaniaamastigotes. A bone marrow biopsy was performed and demonstrated similar intracellular forms. Anal condyloma tissue and bone marrow aspirate were sent to the Centers for Disease Control and Prevention's Parasitic Diseases Branch for confirmation ofLeishmaniaand speciation. Specific immunohistochemical staining forLeishmaniain the tissue section was positive and the species was confirmed asLeishmania donovaniby PCR. Subsequently, the patient resumed highly active antiretroviral therapy and received anti-Leishmaniatherapy.
  
  
  CONCLUSIONS
  Whilst the presentation of VL in HIV-positive patients is often similar to those without HIV, here we describe an unusual initial presentation of leishmaniasis in an HIV-positive patient where the parasite was found in an anal condyloma. VL is a critical diagnosis that should be considered and pursued when leishmaniasis is encountered in seemingly illogical clinical settings.
authors.affiliation: Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis , IN 46202 , USA.
authors.forename: Marijo S
authors.initials: MS
authors.lastname: Roiko
authors.affiliation: Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis , IN 46202 , USA.
authors.forename: Bryan H
authors.initials: BH
authors.lastname: Schmitt
authors.affiliation: Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis , IN 46202 , USA.
authors.forename: Ryan F
authors.initials: RF
authors.lastname: Relich
authors.affiliation: Division of Infectious Disease, Indiana University Health, Indianapolis , IN 46202 , USA.
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Meyer
authors.affiliation: Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis , IN 46202 , USA.
authors.forename: Shanxiang
authors.initials: S
authors.lastname: Zhang
authors.affiliation: Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis , IN 46202 , USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Davis
keywords: HAART; HIV; Leishmania donovani; condyloma; leishmaniasis