GASTROINTESTINAL LEISHMANIASIS IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED PATIENTS - REPORT OF 5 CASES AND REVIEW

We describe five cases of gastrointestinal leishmaniasis in patients w ith human immunodeficiency virus infection and review 10 additional ca ses reported in the literature. All of the patients had CD4+ cell coun ts of <200/mm(3), and AIDS had been previously diagnosed for 12 patien ts. Fever and splenomegaly were present in 46% of cases. Thirteen pati ents had digestive symptoms; these symptoms included diarrhea (6), dys phagia and/or odynophagia (6), abdominal pain (2), epigastric pain (2) , gastrointestinal hemorrhage (1), and rectal discomfort (I). The regi ons of the digestive tract most frequently affected by Leishmania orga nisms were the duodenal mucosa (90%) and the gastric mucosa (75%). End oscopy showed normal-appearing mucosa in 45% of cases. In 10 cases the diagnosis of visceral leishmaniasis was first made by biopsy of the g astrointestinal mucosa. In most cases treatment with antimonial agents was not effective.