Cutaneous Leishmaniasis in AIDS

M. Nicolás, Servicio de Dermatología, Hospital del Mar, Universidad Autónoma de Barcelona, Paseo Marítimo, 25–29, E08003 Barcelona (Spain) Recent data show that 50% of adult HIV-positive patients are also affected by visceral leishmaniasis (VL) in endemic areas and that 1-3% of AIDS patients become infected with VL in the southwest of Europe [ 1 ]. In relation to the immunodeficient state, VL is associated with a poor prognosis [2]. It is therefore suggested that leishmaniasis is an opportunistic infection in HIV-positive patients [3]. Furthermore, since reports of AIDS patients with VL have increased in number, it has been suggested that this infection should be included as a diagnostic criterion for AIDS [3-5]. We report the case of a cutaneous leishmaniasis (CL) whose torpid course, resistance to treatment and histology made us suspect an immunodeficient syndrome. A woman, 39 years old with no relevant antecedents, showed in the left cheek a 2-cm diameter brown nodule that had developed during 1 month (fig. 1). Biopsy showed a huge number of leishmanias within macrophages and confirmed the clinical suspicion (fig. 2). Keto-