A 41-year-old man presented with vomiting and loose stools. He had a history of long-term intermittent fever, generalised skin hyperpigmentation, dragging sensation in the left hypochondrium and unintentional weight loss. He was receiving combination antiretroviral therapy since 2010 for HIV infection. He also received antitubercular therapy for tuberculous spondylitis. During the hospital stay, he was found to have postural hypotension, hypoglycaemia, hyponatraemia, hyperkalaemia, pancytopenia, hypothyroidism, hyperglobulinaemia and hypoalbuminaemia with reversal of serum albumin/globulin ratio. The morning plasma cortisol was lower than normal and could not be appropriately stimulated after the Synacthen test. The bone marrow histopathology was suggestive of visceral leishmaniasis. He was diagnosed as a case of visceral leishmaniasis and HIV coinfection with primary adrenal insufficiency (Addison’s disease) and primary hypothyroidism, as a rare and unusual presentation.

中文翻译：

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内脏利什曼病和 HIV 合并感染的艾迪生病伴原发性甲状腺功能减退症

一名 41 岁男性因呕吐和稀便就诊。他有长期间歇性发热、全身皮肤色素沉着过度、左胁骨拖曳感和无意识体重减轻的病史。自 2010 年以来，他因 HIV 感染接受了联合抗逆转录病毒治疗。他还接受了结核性脊柱炎的抗结核治疗。住院期间，发现体位性低血压、低血糖、低钠血症、高钾血症、全血细胞减少、甲状腺功能减退、高球蛋白血症和低白蛋白血症伴血清白蛋白/球蛋白比值逆转。早晨血浆皮质醇低于正常水平，在 Synacthen 测试后无法适当刺激。骨髓组织病理学提示内脏利什曼病。