Abstract

Visceral Leishmaniasis (VL), and Post Kala-Azar Dermal leishmaniasis (PKDL) are common problems in India, Nepal, Bangladesh, but both diseases can occur simultaneously sometime known as Para-Kala-Azar Dermal Leishmaniasis (Para-KDL). Similarly, HIV-VL co-infection is also common in Indian sub-continent. However, all three types of signs and symptoms occur rarely and have not yet been reported as per our knowledge. In September 2024 a rare case was diagnosed as VL-PKDL & HIV simultaneously in ICMRRMRIMS, Patna. The patient presented as fever with chills, loss of appetite, weakness and splenomegaly and mixed Nodulo-Papular lesions with positive LD bodies in the Splenic aspirates. Patient was also suffering from HIV-1 co-infection as confirmed by ELISA, low CD4+ level (176 cells/mm3) and HIV-RNA viral load (85 copies/ml). The patient was treated with six doses of Liposomal Amphotericin-B along with Miltefosine 50mg twice daily for 14 weeks. Follow-up studies after 5 months of treatment showed that patient was completely cured as signs and symptoms disappeared and he became healthy. Association of Para-KDL and HIV was noticed first time in Indian sub-continent and currently, no treatment guideline is available.

Keywords: Para-KDL; HIV; Liposomal amphotericin B resistance; Miltefosine