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Cutaneous leishmaniasis and rickettsial African tick‐bite fever: a combination of exotic traveler’s diseases in the same patient
Author(s) -
Schwartz Robert A.,
Kapila Rajendra,
McElligott Sean C.,
Atkin Suzanne H.,
Lambert W. C.
Publication year - 2012
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.1365-4632.2011.05362.x
Subject(s) - medicine , chills , leishmaniasis , rickettsia typhi , serology , rocky mountain spotted fever , dermatology , rickettsia rickettsii , malaria , immunology , virology , surgery , spotted fever , rickettsia , antibody , virus
Background Cutaneous leishmaniasis and rickettsial African tick‐bite fever are two zoonoses increasingly diagnosed in industrialized nations due to more international travel to endemic areas. Methods A 52‐year‐old American nurse was evaluated for a 0.5 cm well‐demarcated, tender, shallow ulcer on her wrist, nonproductive cough, fever, chills, and night sweats, all of which began three weeks after travel to Botswana and a visit to a game reserve, where she reported being scratched on the ankle by a cheetah. Results This cutaneous finding was strongly suggestive of leishmaniasis, but the systemic symptoms were perplexing. Although excisional biopsy showed only nonspecific changes, a specimen sent to the United States Centers for Disease Control revealed leishmania promastigotes of L. tropica . Initial Rickettsia typhi titers and many other serologic tests were negative. However, four weeks after admission, R. typhi IgG titer was 1 : 64 and R. rickettsii IgG was 1 : 1024. Conclusion Thus, our patient had two tropical diseases simultaneously.