The presence and significance of Leishmania in mucocutaneous biopsies from HIV+ patients with visceral leishmaniasis

We have detected Leishman-bodies in 5 biopsies obtained from four HIV seropositive patients with kala-azar, which represents 4% of our group of 118 biopsies from 461 infected people seen over a six year period. In two cases, Leishmania coexisted with the histopathological picture of Reiter's syndrome and bacillary angiomatosis, features that may be incidental. In one of these cases, this observation led to the diagnosis of a hitherto undetected visceral leishmaniasis. The other three biopsies came from a non-specific, hyperpigmented macule, a papulosquamous cutaneous lesion and from the edge of an oral ulceration. The role of Leishmania in the pathogenesis, is uncertain, although one hypothesis may explain this feature. Protozoa reach the skin by dissemination after external infection or reactivation of a latent leishmaniasis, and it seems to be clearly related to the general clinical condition, since most of our cases are AIDS patients with severe immunosuppression. Its demonstration, led us to undertake appropriate studies to demonstrate the presence or not of systemic infection. Three of our patients were intravenous drug abusers, but the epidemiological significance of this fact, the main cause of HIV infection in our area, and other etiological and pathological aspects of leishmaniasis in HIV seropositive patients needs more studies in the future before any conclusion can be drawn.