Abstract
Case presentation
Here, we report on a case of VL in an HIV-infected patient from the Republic of Georgia who had moved to Germany 14 years before and who had travelled several times to southern Europe in between. After presenting with typical Pneumocystis jiroveci pneumonia, which was treated appropriately, the patient was started on antiretroviral therapy. Shortly thereafter, however, he developed fever of unknown origin. All laboratory assays for the diagnosis of various infectious agents including serological assays and polymerase chain reaction testing of bone marrow aspirate to diagnose VL did not yield positive results at first. Only upon repetition of these tests, diagnosis of VL could be made and the patient treated accordingly.
Case discussion
Visceral leishmaniasis (VL) is a common opportunistic infection in HIV-positive patients from endemic countries but occurs rarely following antiretroviral treatment. This case demonstrates that patients who develop VL upon immune reconstitution may not be diagnosed initially by standard laboratory assays for the diagnosis of VL and underlines the necessity to repeat serologic and molecular biologic testing for VL in cases of fever of unknown origin in patients from or with travel history to endemic countries.
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Acknowledgments
MP and BS were supported by a grant from the German Ministry of Education and Research (grant numbers 01KI1204).
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Written informed consent was obtained from the patient for publication of this case report. A copy of the written consent is available for review by the Editor-in-Chief of this journal.
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Schleenvoigt, B.T., Ignatius, R., Baier, M. et al. Development of visceral leishmaniasis in an HIV+ patient upon immune reconstitution following the initiation of antiretroviral therapy. Infection 44, 115–119 (2016). https://doi.org/10.1007/s15010-015-0813-7
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DOI: https://doi.org/10.1007/s15010-015-0813-7