{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:32:52Z","timestamp":1787031172214,"version":"build-2736575974"},"reference-count":30,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,7,1]]},"abstract":"<jats:p>\n                    Leishmaniasis is considered an emerging opportunistic disease in human immunodeficiency virus (HIV)\u2013infected patients who have considerably variable clinical presentation. We report a patient with visceral leishmaniasis who had unexpected clinical aspects (atypical cutaneous lesions appearing after long-term evidence of visceral parasites). The patient had hepatoesplenomegaly in the absence of fever, but was otherwise generally healthy. The HIV viral load was low despite severe immunossupression (low lymphocyte proliferation and low level of interferon-\u03b3, concomitant with a high lymphocyte activation status). Surprisingly, two\n                    <jats:italic>Leishmania<\/jats:italic>\n                    strains were isolated from his bone marrow (typical\n                    <jats:italic>L. infantum<\/jats:italic>\n                    sequence MON-1, type A) and skin (\n                    <jats:italic>L. donovani<\/jats:italic>\n                    MON-2 sequence); this second strain had not been previously identified in Brazil. The association of visceral leishmaniasis and HIV\/acquired immunodeficiency syndrome is a largely unknown disease, particularly in areas in which leishmaniasis is not endemic. Such atypical cases indicate that this disease can be undiagnosed in clinical settings.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.2011.10-0398","type":"journal-article","created":{"date-parts":[[2011,7,6]],"date-time":"2011-07-06T14:34:20Z","timestamp":1309962860000},"page":"55-59","source":"Crossref","is-referenced-by-count":22,"title":["Atypical Lesions as a Sign of Cutaneous Dissemination of Visceral Leishmaniasis in a Human Immunodeficiency Virus\u2013Positive Patient Simultaneously Infected by Two Viscerotropic Leishmania Species"],"prefix":"10.4269","volume":"85","author":[{"given":"Joanna R.","family":"Santos-Oliveira","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alda M.","family":"Da-Cruz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy H. S.","family":"Pires","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisa","family":"Cupolillo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrin","family":"Kuhls","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmem B. W.","family":"Giacoia-Gripp","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoel P.","family":"Oliveira-Neto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"issue":"(Suppl 1)","key":"R1","series-title":"Ann Trop Med Parasitol","first-page":"S99","article-title":"Visceral leishmaniasis in those infected with HIV: clinical aspects and other opportunistic infections","volume":"97","author":"Russo","year":"2003"},{"key":"R2","series-title":"Br J Dermatol","first-page":"114","article-title":"Visceral leishmaniasis with cutaneous lesions in a patient infected with human immunodeficiency virus","volume":"139","author":"Ara","year":"1998"},{"key":"R3","series-title":"J Am Acad Dermatol","first-page":"316","article-title":"Leishmania presenting as dermatomyositis-like eruption in 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