Visceral Leishmaniasis of Atypical Location in Immunodepressed Patients: A Report of Two Cases

Abstract

Two cases of atypical location of visceral leishmaniasis in two immunodepressed patients are described. In one case, leishmaniasis was seen involving the mucosa of both the esophagus and duodenum in an acquired immunodeficiency syndrome patient whose initial symptoms were odynophagia and esophagospasm, resulting from an esophageal ulcer. In the second case, leishmaniasis was seen in the mucosa of the colon of a human immunodeficiency virus-seronegative patient suffering from long-standing untreated pulmonary tuberculosis; the initial symptoms were fecal incontinence and diarrhea. Both patients lived in an area where leishmaniasis is endemic. As the condition of both patients improved after treatment with meglumine antimoniate, it is assumed that their symptoms were caused by leishmania organisms. Pathologists working in nonendemic areas should be aware of this protozoon when interpreting alimentary tract biopsies of immunodepressed patients, both human immunodeficiency virus-seropositive and human immunodeficiency virus-seronegative, who have visited areas where leishmaniasis is endemic.