Simultaneous Occurrence of Ocular, Disseminated Mucocutaneous, and Multivisceral Involvement of Leishmaniasis

Leishmaniasis is a tropical infection caused by the protozoan, belonging to the group of Leishmania which causes Old World and New World disease. These are typically divided into cutaneous, mucocutaneous, visceral, viscerotropic, and disseminated disease. Cutaneous leishmaniasis in the presence of visceral disease is a rarity. Isolated case reports have documented this occurrence, in the immunocompromised setting, and few otherwise. The concurrent presence of visceral leishmaniasis (bone marrow involvement) with solitary cutaneous and ocular disease and also solitary cutaneous and visceral disease (bone marrow involvement) has been reported before. Here, we present an immunocompetent patient who was diagnosed to have visceral leishmaniasis (liver and bone marrow involvement) along with simultaneous disseminated mucocutaneous and ocular involvement, a combination that has never been reported before. 1. Introduction Leishmaniasis, caused by an obligate intramacrophage protozoan parasite, belonging to the group Leishmania, is a vector borne disease affecting human population where the parasite, the animal reservoir, and the vector coexist. Sandflies, belonging to the Phlebotomus species, are the vectors responsible for this illness. Leishmaniasis exists in three forms. The less severe form called cutaneous leishmaniasis affects the skin, producing characteristic lesions that can be well managed with treatment. The second form is the more severe visceral leishmaniasis which affects internal organs and can prove to be fatal if not judiciously treated. A third form known as the mucocutaneous leishmaniasis affects skin and mucous membranes of the face, producing ulcerative and disfiguring lesions [1]. Leishmaniasis is commonly seen in the regions of Nepal, India, Bangladesh, and the Middle East. Leishmania is a genus of trypanosomatid protozoa and is spread through bite of sandflies of the genus Phlebotomus in the Old World and genus Lutzomyia in the New World. The cutaneous forms of Leishmaniasis are further characterized into classical cutaneous leishmaniasis, diffuse cutaneous, leishmaniasis recidivans, and post kala-azar dermal leishmaniasis [2]. The other forms include the classical visceral type and viscerotropic type. Concurrent occurrence of these different leishmanial forms in a single host has been reported very rarely in literature [3]. The presence of cutaneous and visceral leishmaniasis has been reported from few countries, mostly in immunocompromised patients. The presence of different forms of leishmaniasis in an immunocompetent host has been