TREATMENT OF ATYPICAL LEISHMANIASIS WITH INTERFERON-GAMMA RESULTING IN PROGRESSION OF KAPOSIS-SARCOMA IN AN AIDS PATIENT

Visceral leishmaniasis (kala-azar) affecting HIV-infected patient is b eing reported in increasing frequency. A 40-year-old German bisexual p atient with full-blown AIDS is described who presented with Kaposi's s arcoma, epigastric pain, diarrhea, and weight loss but without fever. Leishmania amastigotes were initially found in biopsies from stomach, duodenum, and a cutaneous Kaposi's sarcoma lesion but were later also recovered from bone marrow and lymph node. The patient received three courses of a combination of pentavalent antimony and interferon-gamma. In addition to the common side effects such as fever, thrombocytopeni a, and elevated amylase and lipase, a vivid progression of the Kaposi' s sarcoma was noted. Tumor progression was temporally closely associat ed with treatment with interferon-gamma. Because this phenomemon has a lso been observed in other patients, we advise caution when using inte rferon-gamma in patients with Kaposi's sarcoma.