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Introduction <p>People with profound Human Immunodeficiency Virus (HIV)-associated immunosuppression are often prone to multiple opportunistic diseases. The diagnosis can be challenging. We present a case in which a patient was diagnosed with two AIDS defining diagnoses with an overlapping clinical spectrum.</p> Case presentation <p>A 30-year-old person living with known HIV-1 infection presented for re-initiation of antiretroviral therapy after a five-year treatment interruption, reporting weight loss, night sweats, and disseminated reddish-violaceous skin lesions. Laboratory tests showed advanced immunosuppression (CD4 count 20/µl) and high viral load. Bronchoscopy demonstrated no mucosal Kaposi lesions. Histopathological analysis of gastric and duodenal biopsies revealed no evidence of Kaposi’s sarcoma but showed abundant intracellular <i>Leishmania</i> spp. within histiocytes of the lamina propria. Molecular testing by Leishmania ITS1 PCR confirmed <i>L. infantum</i> from gastroduodenal tissue, whole blood and sputum. In contrast, skin biopsy displayed dermal infiltrates characteristic of Kaposi’s sarcoma with concomitant leishmaniasis. The diagnoses of visceral leishmaniasis, Kaposi’s sarcoma, and advanced HIV infection (WHO stage 4&#xa0;/ AIDS) were established. Treatment with liposomal amphotericin B and antiretroviral therapy was well tolerated and led to clinical improvement.</p> Conclusion <p>This case highlights how visceral leishmaniasis can mimic Kaposi’s sarcoma in people living with HIV, posing a major diagnostic challenge. Early recognition and comprehensive workup are essential, and rising climatic suitability underlines the need for heightened clinical awareness beyond classical endemic areas.</p>

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Visceral leishmaniasis clinically disguised as Kaposi’s sarcoma: a diagnostic challenge in people living with HIV

  • 期刊论文

  • 发表日期：

    2026年3月6日

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  • Lene T. Tscharntke,
  • Theresa Alisch,
  • Gerrit Burger,
  • Elifsah Pfister,
  • Tobias Weirauch,
  • Maria J. G. T. Vehreschild,
  • Sigrid Möckel,
  • Elise Gradhand,
  • Timo Wolf

摘要

Introduction

People with profound Human Immunodeficiency Virus (HIV)-associated immunosuppression are often prone to multiple opportunistic diseases. The diagnosis can be challenging. We present a case in which a patient was diagnosed with two AIDS defining diagnoses with an overlapping clinical spectrum.

Case presentation

A 30-year-old person living with known HIV-1 infection presented for re-initiation of antiretroviral therapy after a five-year treatment interruption, reporting weight loss, night sweats, and disseminated reddish-violaceous skin lesions. Laboratory tests showed advanced immunosuppression (CD4 count 20/µl) and high viral load. Bronchoscopy demonstrated no mucosal Kaposi lesions. Histopathological analysis of gastric and duodenal biopsies revealed no evidence of Kaposi’s sarcoma but showed abundant intracellular Leishmania spp. within histiocytes of the lamina propria. Molecular testing by Leishmania ITS1 PCR confirmed L. infantum from gastroduodenal tissue, whole blood and sputum. In contrast, skin biopsy displayed dermal infiltrates characteristic of Kaposi’s sarcoma with concomitant leishmaniasis. The diagnoses of visceral leishmaniasis, Kaposi’s sarcoma, and advanced HIV infection (WHO stage 4 / AIDS) were established. Treatment with liposomal amphotericin B and antiretroviral therapy was well tolerated and led to clinical improvement.

Conclusion

This case highlights how visceral leishmaniasis can mimic Kaposi’s sarcoma in people living with HIV, posing a major diagnostic challenge. Early recognition and comprehensive workup are essential, and rising climatic suitability underlines the need for heightened clinical awareness beyond classical endemic areas.