The changing spectrum of cutaneous leishmaniasis and HIV coinfection in Bolivian Amazonia: a case report.

CASE REPORT: A 34-year-old man with advanced HIV infection presented with localized cutaneous leishmaniasis, after unsuccessful trestment with pentavalent antimonials, progressive dissemination ocurred . On re-evaluation, he exhibited numerous widespread ulcerated papules and nodules , accompanied by systemic symptoms and significant weight loss. Skin smears and histopathology demonstrated intracellular amastigotes. A diagnosis of intermediate cutaneous leishmaniasis with HIV coinfection was established. Treatment with liposomal amphotericin B followed by oral miltefosine led only to transitory clinical resolution. DISCUSSION: This case highlights the diagnostic and therapeutic challenges of leishmaniasis in immunocompromised patients and underscores the dynamic nature of the clinical classification of cutaneous leishmaniasis.