Para-KDL in HIV co-infection: case report of a rare visceral-cutaneous leishmaniasis syndrome

Abstract Introduction Para-Kala-Azar Dermal Leishmaniasis (para-KDL) is a rare manifestation of leishmaniasis that occurs concurrently with active Visceral Leishmaniasis (VL). It is characterized by a combination of cutaneous and systemic symptoms, posing diagnostic and therapeutic challenges. This condition is even more complex in immunocompromised patients, such as those with HIV. Case presentation We report a case of a 52-year-old male from south of Iran, who presented with prolonged fever, severe weight loss, pancytopenia, and massive splenomegaly. The patient was diagnosed with HIV and had been receiving antiretroviral therapy (ART). He underwent a splenectomy 1 month later and developed progressive generalized lymphadenopathy and hepatomegaly 5 months after that. Histopathological analysis of lymph node biopsies confirmed leishmaniosis, and the patient was started on Meglumine antimoniate. Shortly after, he developed widespread maculopapular skin lesions. Subsequent diagnostic evaluations, including skin biopsy, confirmed the presence of Leishman bodies. The patient was successfully treated with liposomal amphotericin B, leading to significant clinical improvement. Conclusion The co-existence of active VL and PKDL can make diagnosis difficult, potentially leading to misdiagnosis and treatment, particularly in immunocompromised patients. The simultaneous occurrence of VL and PKDL-like skin lesions requires heightened clinical suspicion, especially in endemic regions. Delayed or misdiagnosed cases may lead to significant morbidity. Further research is needed to understand the pathophysiology, immune response, and optimal treatment strategies for para-KDL in HIV-infected individuals.