Coinfection of visceral leishmaniasis and Mycobacterium in a patient with acquired immunodeficiency syndrome

We report a case of coinfection of visceral leishmaniasis and Mycobacterium avium-intracellulare in the same lesions in the small bowel and bone marro w of a 33-year-old man with acquired immunodeficiency syndrome who complain ed of abdominal pain and chronic diarrhea. The duodenal mucosa and bone mar row biopsy specimens showed numerous foamy macrophages packed with two form s of microorganisms that were identified histologically and ultrastructural ly as Leishmania and Mycobacterium species. Visceral leishmaniasis is rarel y suspected in patients residing in nonendemic countries including the Unit ed States. It should be included in the differential diagnosis for opportun istic infection in patients with acquired immunodeficiency syndrome. An app ropriate travel history is important. To our knowledge, this is the first r eported case showing coinfection of visceral leishmaniasis and Mycobacteriu m avium-intracelluulare in the same lesion in a patient with acquired immun odeficiency syndrome.