{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:47:11Z","timestamp":1782841631148,"version":"3.54.5"},"reference-count":20,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001807","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de S\u00e3o Paulo","doi-asserted-by":"publisher","award":["#2014\/50315\u20100"],"award-info":[{"award-number":["#2014\/50315\u20100"]}],"id":[{"id":"10.13039\/501100001807","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Parasite Immunology"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    HIV\u2010associated Immune Reconstitution Inflammatory Syndrome (IRIS) may significantly alter the immunopathological presentation of American Tegumentary Leishmaniasis (ATL), occasionally causing paradoxical clinical exacerbations. We report the long\u2010term follow\u2010up of a 39\u2010year\u2010old female coinfected with HIV and disseminated mucocutaneous leishmaniasis caused by\n                    <jats:italic>Leishmania<\/jats:italic>\n                    (\n                    <jats:italic>Viannia<\/jats:italic>\n                    ) sp., who experienced severe lesion exacerbation four months after initiating High\u2010Activity Antiretroviral Therapy (HAART). Despite successful viral suppression and CD4+ T\u2010cell recovery, she developed aggressive mucocutaneous plaques with nasal septum destruction. Immunohistochemical analysis of a skin biopsy revealed a profile distinct from HIV\u2010negative ATL controls: classic pro\u2010inflammatory markers (CD68, iNOS, IL\u20106, and IL\u201017) were markedly suppressed, while CD163, IL\u201010, TGF\u2010\u03b2 and IL\u201018 were elevated, signalling M2 macrophage activation and paradoxical Th2 polarisation. CD8+ T cells were the most preserved lymphocyte subset, which is consistent with their reported cytotoxic, tissue\u2010damaging role in mucosal leishmaniasis caused by\n                    <jats:italic>L.<\/jats:italic>\n                    (\n                    <jats:italic>Viannia<\/jats:italic>\n                    )\n                    <jats:italic>braziliensis<\/jats:italic>\n                    . Standard pentavalent antimonial combined with sustained HAART led to complete resolution without recurrence over 16\u2009years. This case illustrates how IRIS may be associated with atypical Th2\u2010polarised pathology and CD8\u2010mediated tissue injury in ATL, highlighting the need for awareness of this presentation in coinfected patients from endemic areas.\n                  <\/jats:p>","DOI":"10.1111\/pim.70082","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T11:00:38Z","timestamp":1778497238000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Tegumentary Leishmaniasis Associated With Immune Reconstitution in an\n                    <scp>HIV<\/scp>\n                    Patient\u2014A Case Report"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2706-3880","authenticated-orcid":false,"given":"Marilia Brasil","family":"Xavier","sequence":"first","affiliation":[{"name":"Research Laboratory in Tropical Dermatology and Endemic Diseases, Nucleus of Tropical Medicine Federal University of Par\u00e1  Bel\u00e9m Par\u00e1 Brazil"},{"name":"Infectious Diseases Pathology Laboratory (LIM50), Pathology Department, Medical School S\u00e3o Paulo University  S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9909-9466","authenticated-orcid":false,"given":"Claudia Maria de Castro","family":"Gomes","sequence":"additional","affiliation":[{"name":"Infectious Diseases Pathology Laboratory (LIM50), Pathology Department, Medical School S\u00e3o Paulo University  S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8330-6667","authenticated-orcid":false,"given":"Rita Catarina Medeiros","family":"Sousa","sequence":"additional","affiliation":[{"name":"Research Laboratory in Tropical Dermatology and Endemic Diseases, Nucleus of Tropical Medicine Federal University of Par\u00e1  Bel\u00e9m Par\u00e1 Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1017-3012","authenticated-orcid":false,"given":"Edna Aoba Yassui","family":"Ishikawa","sequence":"additional","affiliation":[{"name":"Research Laboratory in Tropical Dermatology and Endemic Diseases, Nucleus of Tropical Medicine Federal University of Par\u00e1  Bel\u00e9m Par\u00e1 Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7178-7750","authenticated-orcid":false,"given":"Elza Ba\u00eda de","family":"Brito","sequence":"additional","affiliation":[{"name":"Research Laboratory in Tropical Dermatology and Endemic Diseases, Nucleus of Tropical Medicine Federal University of Par\u00e1  Bel\u00e9m Par\u00e1 Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5714-8466","authenticated-orcid":false,"given":"Silvia Ferreira Rodrigues","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Medicine School Federal University of Par\u00e1  Bel\u00e9m Par\u00e1 Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0588-4461","authenticated-orcid":false,"given":"Lucas dos Santos","family":"Fontes","sequence":"additional","affiliation":[{"name":"Research Laboratory in Tropical Dermatology and Endemic Diseases, Nucleus of Tropical Medicine Federal University of Par\u00e1  Bel\u00e9m Par\u00e1 Brazil"},{"name":"Infectious Diseases Pathology Laboratory (LIM50), Pathology Department, Medical School S\u00e3o Paulo University  S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7286-7066","authenticated-orcid":false,"given":"Jo\u00e3o Augusto Gomes de Souza Monteiro de","family":"Brito","sequence":"additional","affiliation":[{"name":"Research Laboratory in Tropical Dermatology and Endemic Diseases, Nucleus of Tropical Medicine Federal University of Par\u00e1  Bel\u00e9m Par\u00e1 Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3918-1585","authenticated-orcid":false,"given":"Larissa dos Santos","family":"Alcantara","sequence":"additional","affiliation":[{"name":"Infectious Diseases Pathology Laboratory (LIM50), Pathology Department, Medical School S\u00e3o Paulo University  S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1587-3085","authenticated-orcid":false,"given":"Carlos Eduardo Pereira","family":"Corbett","sequence":"additional","affiliation":[{"name":"Infectious Diseases Pathology Laboratory (LIM50), Pathology Department, Medical School S\u00e3o Paulo University  S\u00e3o Paulo S\u00e3o Paulo 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