Ricardo Enríquez, Ana Esther Sirvent, Sergio Padilla, Paula Toro, María Sánchez, Isabel Millán
(Nephrology Section, Hospital General Universitario de Elche, Elche, Spain)
Am J Case Rep 2015; 16:8-11
Visceral leishmaniasis is an important opportunistic disease in HIV-positive patients. The information available on the effects of such co-infection in the kidney is limited. We describe a patient with HIV/leishmania coinfection who developed nephrotic syndrome and membranoproliferative glomerulonephritis. As far as we know, only 2 cases of this nephropathy in HIV/leishmania coinfection have been reported.
Case Report: A 47-year-old man developed nephrotic syndrome. He had been diagnosed with HIV infection and visceral leishmaniasis and was treated with antiretroviral therapy, antimonial compounds, liposomal amphotericin B and miltefosine, but the leishmania followed a relapsing course.
Renal biopsy disclosed membranoproliferative glomerulonephritis and leishmania amastigotes were seen within glomerular capillary lumens. He was given miltefosine and liposomal amphotericin B but the leishmaniasis persisted. Stage 3B chronic renal disease and nephrotic range proteinuria tend to become stable by 15-month follow-up.
Conclusions: Our case illustrated some aspects of leishmaniasis in HIV patients: its relapsing course, the difficulties in therapy, and the renal involvement.
Keywords: AIDS-Related Opportunistic Infections - virology, Biopsy, Diagnosis, Differential, Glomerulonephritis, Membranoproliferative - etiology, HIV, Humans, Kidney Glomerulus - pathology, Leishmaniasis, Visceral - diagnosis, Male, Middle Aged