The presence of HIV RNA was not detected by polymerase chain reaction (PCR). The absolute CD4 was found to be 465 cells/µL (normal 395–1601 cells/µL) and may have accounted for the development of oral candidiasis. Angiotensin-converting enzyme and immunoglobulin levels were normal. Rapid plasma reagin and tuberculin skin test were nonreactive. Computed tomography of the chest, abdomen, and pelvis was remarkable only for splenic lesions consistent with granulomatous disease. Bone marrow biopsy also demonstrated granulomas. Additional confirmatory testing performed by the Leishmania Diagnostic Laboratory at Walter Reed Army Institute
selleck chemicals llc of Research included a positive Leishmania genus-specific PCR of the tongue sample and rK39 dipstick assay was strongly positive. The PCR was unable to make an identification at the species level. Cultures done on the tissue from the tongue and bone marrow remained
negative. Following definitive diagnosis, the patient received lipsomal amphotericin B 3 mg/kg intravenously on days 1 to 5, followed by additional doses on days 9 and 16. On last follow-up 1 week after the final amphotericin infusion, the patient was doing remarkably well with complete resolution of his night sweats and a 10-pound weight gain. In addition, the tongue was healing well, the liver enzymes click here had nearly normalized, and the platelet count had increased. Commonly classified into Old World and New World disease, the World Health Organization estimates that presently 12 million people are infected with leishmaniasis worldwide and 2 million new cases occur annually. The spectrum of clinical disease is classically divided into cutaneous, mucocutaneous, and visceral leishmaniasis. Mucocutaneous disease typically occurs in the New World, and 90% of visceral disease is found in eastern India, Bangladesh, the Sudan, and Brazil.1 Cutaneous and visceral illness has been well described in US military personnel serving in Afghanistan, Iraq, Saudi Arabia, RVX-208 and Kuwait.2–4 Leishmaniasis of the tongue is not commonly reported. It has been
described primarily among immunocomprimised patients with HIV, malignancy, organ transplant, and corticosteroid use.5–8 Only rare cases of lingual leishmaniasis have been reported as occurring in immunocompetent hosts.9–11 Various laboratory abnormalities can be seen with visceral disease including thrombocytopenia, anemia, leukopenia, elevated liver function tests, hypoalbuminemia, and hypergammaglobulinemia.1 Definitive diagnosis of leishmaniasis requires demonstration of the organism by histology, culture, or PCR. In our case, definitive diagnosis of mucocutaneous involvement was made by the visualization of amastigotes and positive PCR from the tongue biopsy. Visceral involvement was suggested by the presence of granulomas in both the liver and the bone marrow.