Visceral and cutaneous leishmaniasis in a person living with HIV

Leishmaniasis, the third most common parasitic infection in persons living with HIV, typically presents in cutaneous, mucocutaneous, or visceral forms. This case report describes a 24-year-old male with advanced HIV/AIDS (CD4+ count 3 cells/mm³) who presented with neurological deterioration due to cerebral toxoplasmosis. During hospitalization, he developed atypical genital ulcers and persistent pancytopenia. Bone marrow examination revealed amastigotes consistent with <i>Leishmania</i> spp., indicating concurrent visceral and mucocutaneous leishmaniasis. Treatment with liposomal amphotericin B followed by miltefosine resulted in clinical improvement of the genital ulcers. This case highlights the atypical presentation of leishmaniasis in a patient living with HIV, deviating from classic descriptions and underscoring the diagnostic challenges. The presence of <i>Leishmania</i> amastigotes in the bone marrow, coupled with unusual cutaneous manifestations, emphasizes the need for a high index of suspicion for opportunistic infections in patients living with HIV/AIDS with unexplained findings, even without a history of travel to endemic areas. Timely diagnosis through bone marrow examination and appropriate multi-drug therapy are crucial for managing such complex co-infections.