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A rare case of leishmaniasis recidiva cutis evolving for 31 years caused by Leishmania tropica
Author(s) -
Stefanidou Maria P.,
Antoniou Maria,
Koutsopoulos Athanassios V.,
Neofytou Yiannakis T.,
Krasagakis Konstantinos,
KrügerKrasagakis Sabine,
Tselentis Yiannis,
Tosca Adroniki D.
Publication year - 2008
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1111/j.1365-4632.2008.03240.x
Subject(s) - medicine , leishmania tropica , scars , cutaneous leishmaniasis , leishmaniasis , meglumine antimoniate , pathology , dermatology , lesion , leishmania , biopsy , parasite hosting , world wide web , computer science
A 64‐year‐old woman presented with erythematous, infiltrative plaques with a central atrophic area on both zygomatic regions. Several yellow‐reddish papules were seen at the periphery of the plaques and showed an “apple‐jelly” color on diascopy ( Fig. 1). No visceral involvement was detected. 1Erythematous, infiltrative plaque with a central atrophic area The past medical history revealed that, at 3 years of age, she had developed an “Oriental sore” on both cheeks that healed with permanent scars. Thirty years later, she noticed an erythematous patch around the scars. She reported a hospital admission 22 years earlier for cutaneous leishmaniasis (CL); this was treated with pentavalent antimonial therapy for 10 days with partial improvement, when she refused further treatment. The lesions worsened in the summer and gradually became disfiguring, which prompted her to seek medical consultation. Laboratory findings were normal. Leishmania antibody titers were negative. Tissue samples were obtained by biopsy from the border of the lesion for culture, polymerase chain reaction (PCR), and histopathologic examination. Histology revealed a dermal infiltrate with tuberculoid granulomas surrounded by lymphocytes, histiocytes, and some plasma cells, but no caseation necrosis. A few Leishmania organisms were found on careful searching ( Fig. 2). Leishmania tropica was identified by culture and PCR. 2(A) Granulomatous infiltrate intermingled with lymphocytes and histiocytes in the dermis (hematoxylin and eosin, ×40). (B) Granulomas lack caseation necrosis (hematoxylin and eosin, ×200). (C) Leishmania organisms in the cytoplasm of a giant cell (Giemsa stain, × 600) A diagnosis of leishmaniasis recidiva cutis (LRC) was made on the basis of the anamnestic data together with the clinical, histopathologic, biologic, and molecular findings. Complete regression was achieved with meglumine antimoniate (Glucantime) given intramuscularly (15 mg Sb V /kg/day for 15 days) and cryosurgery with liquid nitrogen. No recurrence was noted during a 12‐month follow‐up period.