Disseminated Leishmaniasis With Immune Reconstitution Inflammatory Syndrome–associated Pneumocystis Pneumonia in a Human Immunodeficiency Virus–infected Patient With First-line Antiretroviral Therapy FailureGupta, Pulin Kumar, MD*; Mahto, Subodh Kumar, MD*; Mittal, Abhishek, MD*; Chawla, Mahinder Pal S., MD*; Kaushal, Manju, MD†; Kumar, Arvind, MD*Infectious Diseases in Clinical Practice: May 2019 - Volume 27 - Issue 3 - p e8–e10 doi: 10.1097/IPC.0000000000000733 Case Report Buy Abstract In Brief Author InformationAuthors Article MetricsMetrics Disseminated atypical leishmaniasis is a stage IV defining illness in people with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome. Although visceral leishmaniasis is endemic in some regions of India, atypical disseminated leishmaniasis is not reported frequently. Patients of visceral leishmaniasis in HIV/acquired immunodeficiency syndrome present with atypical manifestations like involvement of upper or lower gastrointestinal tract, lungs, pleura, liver, kidney, skin, and peritoneum and have chronic progression with relapses irrespective of treatment given. We hereby report a case of atypical disseminated leishmaniasis in an HIV-positive patient, who also developed Pneumocystis pneumonia as a part of immune reconstitution syndrome after failure of first-line antiretroviral therapy. Our patient also had involvement of gastrointestinal tract and lymph nodes which has rarely been reported from Indian subcontinent. Patients with HIV/AIDS with profound immunosuppression can present with atypical disseminated leishmaniasis with involvement of atypical sites like gastrointestinal tract and lymph nodes, which may not respond to the available gold standard drugs like amphotericin B. Physicians must also keep in mind that not all immunological failures are drug failures. An occult opportunistic infection should always be ruled out before opting for second-line antiretroviral therapy From the Departments of *Medicine and †Pathology, PGIMER, Dr. RML Hospital, New Delhi, India. Correspondence to: Subodh K. Mahto, MD, Department of Medicine, PGIMER, Dr. RML Hospital, New Delhi, 110001, India. E-mail: firstname.lastname@example.org. The authors have no funding or conflicts of interest to disclose. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.