Visceral Leishmaniasis–Leprosy Co-infection in a Patient Living with HIV: A Case Study

Leprosy and visceral leishmaniasis are two chronic infectious diseases resulting from intracellular pathogens whose clinical expression is largely the result of host cell-mediated immunity. Yet the concomitant occurrence of them in patients living with HIV remains exceedingly rare. This gives substantial diagnostic and therapeutic difficulties. The work studies a case of a 26-year-old Moroccan man, with HIV infection. Since August 2023 he has been receiving ART triple therapy as well as cotrimoxazole prophylaxis. He presents with a four-month history of progressive, diffuse, infiltrating papulo-nodular cutaneous lesions surrounding the body such as the face, trunk, and limbs, associated with leonine facies, eyebrow depilation, ulcerated nodules, and ENT manifestations. Laboratory workup showed pancytopenia with aregenerative anemia. Bone marrow aspirate showed significant hypoplasia of the three hematopoietic lineages, with significant intra- and extramacrophagic infiltration by Leishmania spp. amastigotes. Simultaneously, a skin biopsy showed histological appearance compatible with lepromatous leprosy; and Ziehl-Neelsen staining of nasal mucus suggested many acid-fast bacilli clustered in the form of globi, consistent with Mycobacterium leprae. It was also noted there to be two opportunistic intracellular pathogens as co-infection carriers of leprosy in such a severely immunocompromised host. It underscores the imperative to expand diagnostic reasoning in the face of diffuse dermatological and hematological presentations in persons living with HIV, and particularly in tropical or endemic settings and suggests the need for close interdisciplinary collaboration to maximize the recovery detection and management of these rare correlations.