Case report Generalized cutaneous leishmaniasis in acquired immunodeficiency syndrome 1 J.B. Rosatelli a , C.S. Souza a , F.A. Soares b , N.T. Foss a , A.M.F. Roselino a, * a Division of Dermatology, School of Medicine of Ribeira ˜o Preto, University of Sa ˜o Paulo, Division of Dermatology, Av. Bandeirantes 3900, 14049-900 Ribeira ˜o Preto, Sa ˜o Paulo, Brazil b Departament of Pathology, School of Medicine of Ribeira ˜o Preto, University of Sa ˜o Paulo, Sa ˜o Paulo, Brazil Abstract Background Leishmaniasis associated with HIV/AIDS has been reported in the last decade. Case report A case of generalized cutaneous leishmaniasis in a patient with AIDS is described. The case is paradoxical in that the cutaneous lesions resemble anergic leishmaniasis caused by Leishmania (L.) amazonensis and Jorge Lobo’s disease, but the positive Montenegro test and the clinical improvement with antimonial are more commonly observed in leishmaniasis caused by L.(V.) braziliensis. Comment The immunosuppression due to HIV/AIDS seen in this patient may explain the dissemination of the lesions, but the positive specific response to leishmanial antigen may explain the good response to the antimonial treatment.  1998 Elsevier Science B.V. Keywords: Leishmaniasis; Cutaneous leishmaniasis; AIDS; L. amazonensis; L. braziliensis 1. Case report In June 1994, a 25-year-old male presented with a 1-year history of a large nodular lesion on the dorsum of his right hand and was admitted to the Division of Dermatology, Clinical Hospital of School of Medi- cine, Ribeira ˜o Preto. He had a past history of pneu- monitis, weight loss and a positive HIV test in November 1993. He was seen in another service in March 1994 with disseminated erythematous nodular skin lesions and diagnosed as AIDS with histoplasmo- sis, which was treated with amphotericin B (total dose 1.0 g) without improvement. The patient had always lived in urban environments, and often camped by the riverside near Ribeira ˜o Preto: he denied use of intra- venous drugs or homosexuality; his last sexual partner was a seropositive HIV woman. On examination, slight mucocutaneous pallor, low weight and general- ized lymphadenopathy was noted. There was no liver or spleen enlargement. A large (6.0 cm diameter) lesion was seen at the dorsum of right hand (Fig. 1, lower left) together with disseminated papulo-tuberous lesions on the arm, some with keloidal appearance similar to lobomyco- sis, but with no mucosal involvement (Fig. 1, top left). Journal of the European Academy of Dermatology and Venereology 10 (1998) 229–232 0926-9959/98/$19.00  1998 Elsevier Science B.V. All rights reserved PII S0926-9959(98)00014-2 * Corresponding author. Tel./fax: +55 16 6330236; e-mail: roselino@spider.usp.br 1 Poster presentation at The Year of Louis Pasteur International Symposia, Etiology and Pathogenesis of Infectious Disease, Dakar, Se ´ne ´gal, April 10–13, 1995.