A Case of Visceral Leishmaniasis Presenting as Seropositive Erosive Rheumatoid Arthritis in an Immunocompromised Patient

This case study describes a 46-year-old Caucasian male with HIV and hepatitis B who presented with symptoms resembling seropositive erosive rheumatoid arthritis (RA) but was ultimately diagnosed with visceral leishmaniasis (VL). The patient exhibited skin nodules, arthralgia, and weight loss, and had positive rheumatoid factor, anti-CCP, ANA, and anti-Ro antibodies. Initial treatment for RA was adjusted after further investigation confirmed VL through biopsies and blood tests. Treatment with amphotericin B and miltefosine led to improvement in symptoms. This case highlights the complex interplay between autoimmune diseases and chronic infections, emphasizing the importance of considering chronic infections like VL in differential diagnoses, especially in immunocompromised patients with systemic symptoms. A multidisciplinary approach was crucial in managing this challenging case.