Diffuse Cutaneous Leishmaniasis Caused by Leishmania major as the Initial Presentation of HIV Misdiagnosed as Scabies and Kaposi's Sarcoma: A Case Report.

Diffuse cutaneous leishmaniasis (DCL) is a rare and severe form of cutaneous leishmaniasis (CL), particularly uncommon in Uzbekistan. Leishmaniasis remains a major opportunistic infection in immunocompromised individuals, especially in those with HIV, where co-infection with Leishmania spp. can result in atypical clinical manifestations, delayed diagnosis, and poor treatment response. This is a retrospective descriptive case report of a single pediatric patient. We report the first known case of DCL in an HIV-infected pediatric patient in Uzbekistan. A 14-year-old boy presented with multiple, non-ulcerative, progressively worsening skin lesions on the face and extremities over six months. Although he had no travel history to known endemic areas, he resided in a region with reported local transmission. Physical examination revealed extensive infiltrative plaques and nodules. Laboratory investigations, including Giemsa staining and PCR, confirmed Leishmania infection. Histopathological analysis showed both intravascular and extravascular amastigotes, and species identification revealed L. major. Imaging ruled out visceral involvement. Given the patient's immunosuppressed status and the disseminated skin involvement, a diagnosis of DCL was established. Liposomal amphotericin B was initiated as first-line therapy. This case illustrates the diagnostic complexities of leishmaniasis in HIV-positive patients, where initial misdiagnoses (e.g., scabies or Kaposi's sarcoma) may delay appropriate treatment. It highlights the critical need for heightened clinical suspicion, better diagnostic tools, and improved physician awareness in endemic and emerging transmission areas. In the context of rising HIV rates and growing domestic tourism to endemic zones, early screening and structured public health interventions are essential to reduce disease burden and improve patient outcomes in Uzbekistan.