An Eritrean-born man observed over an extended period had upper gastrointestinal symptoms, fever, hepatosplenomegaly and pancytopenia in the setting of advanced HIV infection and poor adherence to antiretroviral therapy. Despite thorough investigation, it was not until a repeat gastroscopic examination and gastric biopsy were performed 18 months after initial presentation that Leishmania infection was diagnosed. The species was identified by polymerase chain reaction assay as L. donovani. Physicians managing HIV-infected patients from regions where Leishmania is endemic should consider visceral leishmaniasis, even in patients who have not lived in a Leishmania-endemic region for many years.
A 42-year-old Eritrean-born man who had previously lived in Sudan arrived in Australia in 1995. He had not travelled overseas since that time. He was diagnosed with HIV infection in 1996. He presented in 2005 with a 2-month history of odynophagia, dysphagia and vomiting.
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