Unusual endoscopic findings in an immunosuppressed patient.

Abstract

Immunosuppressed patients are susceptible to infections by opportunistic agents such as Leishmania that could cause visceral leishmaniasis with gastrointestinal involvement in up to 10 % of cases. We report a 41-year-old man with human immunodeficiency virus (HIV) infection stage C3 with CD4 lymphocytes 81/mm3, 4,070 leukocytes (47.2 % lymphocytes, 0.0 % eosinophils, rest of differential normal) treated with antiretroviral therapy (dolutegravir/abacavir/lamivudine) with good adherence. He also reported mesangiocapillary glomerulonephritis type-1, hepatocutaneous porphyria, and a 7-year history of recurrent visceral leishmaniasis treated with liposomal amphotericin B as secondary prophylaxis. Esophagogastroduodenoscopy and colonoscopy indicated for chronic diarrhea and anemia performed 5 years ago displayed antral erythema, mild nodular appearance in the duodenal mucosa, and normal colonic mucosa. Gastric, duodenal, and colonic biopsies revealed Leishmania spp despite treatment with liposomal amphotericin B.