Leishmaniasis recidiva cutis

A 62‐year‐old white woman presented with an 8‐month history of a slowly and progressively growing, erythemato‐infiltrative plaque on her right temporo‐malar region. The lesion was originally described as reddish, confluent papules, expanding at the periphery and leaning towards the scarring resolution in the central area. Physical examination revealed an extensive atrophic area, of 4 cm in diameter, with confluent, small, yellow‐brown, scaly papules surrounding it, localized on the right temporo‐malar region ( Fig. 1). On diascopy, ‘‘apple‐jelly‐like nodules’' were seen at the periphery. A complete clinical evaluation showed the patient in good health. The results of the routine laboratory tests were normal. 1Extensive atrophic plaque with dusky hypertrophic border of the face A punch‐biopsy (3 mm in diameter) was performed at the border of the plaque for histologic study. The tissue sections, stained with hematoxylin and eosin, showed acanthosis and a granulomatous dermal infiltrate composed of lymphohistiocytic cells, a few plasma cells, and Langhans epithelial giant cells ( Fig. 2). No areas of necrosis were seen. The apposition of the skin biopsy, followed by the May‐Grunwald stain, showed rare Leishman's bodies. 2Histopathology of the skin „lesion showing typical granulomatous dermal infiltrate During detailed questioning, the patient stated that 1 year previously a micropapular lesion, mosquito‐bite‐like, appeared in the same area of the present plaque and healed after 2 weeks of therapy with an undefined topical antibiotic. These anamnestic data, together with the clinical and histopathologic findings, support the diagnosis of leishmaniasis recidiva cutis (LRC). The patient was treated with intralesional meglumine antimonate (Glucantim) (twice in a week for 3 weeks). At the end of therapy an atrophic plaque remained. After 5 years of follow‐up no relapses were found.