EDL patient, 43 years old, Caucasian, male, gardener, coming from Ceara and a resident of Rio de Janeiro for four years, complained of odynophagia progressively worsening over four months, weight loss, fever was not measured, anorexia and night sweats. On physical examination the patient was in good general health, malnutrition, anicteric, eupneic, hydrated, with destructive ulcerative lesion affecting the soft palate and posterior oropharyngeal wall, linear gingival erythema, white lesions on the edge of the tongue compatible with bilateral hairy leukoplakia, multiple infarcted lymph nodes, painless, mobile cervical chain bilaterally, laryngoscopy showed that the lesion also undertook the hypopharynx and the epiglottis, the rhino and otoscopy were within normal limits. The diagnostic hypotheses were: AIDS a disease associated with granulomatosis or median lethal granulomas syndrome. Thus workup was based on: HIV serology, PPD, Montenegro reaction, blood cells counts, Coagulogram, c-ANCA, p-ANCA, western blot and histological examination of material from the lesion of the soft palate. The results showed: HIV reagent, western blot HIV1 group O, weak PPD reactor, Montenegro skin strong reactor (20mm), pancytopeny, c-ANCA and p-ANCA negative and histopathology demonstrated inclusions in macrophages consistent with the amastigote form of Leishmania . The patient was referred to a reference center for treatment of infectious disease where he started antiretroviral therapy and full dose Leishmaniasis (liposomal amphotericin). Currently the patient meets the lesions in the pharynx and stage of immune recovery.