We describe herein a patient with advanced HIV-1 infection residing in a non-endemic area for leishmaniasis. The diagnosis of HIV had been made 4 years prior to this admission. Unfortunately, the Centers for Disease Control and Prevention (CDC) stage at the time of diagnosis was not known. He presented with atypical features of visceral leishmaniasis. In particular, the patient had dissemination to the esophagus, the stomach, and to the skin.