In January, 2009, a 34-year-old man presented to our hospital with a 6-month history of four, well-defined, non-tender, erythematous plaques of area 1-3 cm~2 on his right hand (figure A). Parasitological examination of a skin smear and biopsy sample confirmed a diagnosis of cutaneous leishmaniasis. Restriction-fragment length polymerisation PCR identified1 the causative species as Leishmania tropica. Our patient also had oral candidosis. He had no history of overseas travel, but his work as a truck driver took him all over India and he had had multiple sexual contacts with sex workers from many regions. HIV infection was confirmed by ELISA HIV TRI-DOT and HIV COMB (Delhi, India). His viral load was 145 600 copies per mL and CD4-cell count was 180 per muL.
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