An atypical presentation of cutaneous leishmaniasis

IMAGES IN INFECTIOUS DISEASES

An atypical presentation of cutaneous leishmaniasis

Valdir Sabbaga Amato^I; Adriana Coracini Tonacio^II; Manoella do Monte Alves^II

^IDivision of Infectious and Parasitic Diseases at the Hospital of Clinics, School of Medicine, University of São Paulo, São Paulo, SP, Brazil

^IIDepartment of Infectious and Parasitic Diseases, Hospital of Clinics, School of Medicine, University of São Paulo, São Paulo, SP, Brazil

^{Address to}

A 52-year-old woman was referred to our service because of a painful skin lesion that had been progressing for five months. Initially, it was just an insect bite, but it evolved into an ulcer on her left leg (Figure A). The ulcer was necrotic and exudative, with a granulated base, and its diameter was 10 centimeters. Tissue scraping was performed, and the presence of amastigotes of Leishmania sp was confirmed by examination under a microscope and by immunohistochemical methods. Antimicrobial therapy for secondary infection, in association with 2.4g of intravenous liposomal amphotericin B (total dose: 40mg/kg of body weight), was prescribed. Figure B shows the evolution of the cutaneous lesion at the end of the treatment. A plastic surgery procedure was performed to cover the remaining ulcer (Figure C). This kind of cutaneous leishmaniasis was atypical, because its size was larger than what is usually described. Certain factors may have contributed towards this evolution, such as diabetes and secondary infection.

Received in 10/12/2009

Accepted in 04/02/2010

• ¹
  Ministério da Saude, Secretaria de Vigilância em Saude. Manual de Vigilancia da Leishmaniose Tegumentar Americana. 2ª. Edição, Brasilia. Editora do Ministério da Saude; 2007.
• 2. Sampaio RN, Marsden PD. Treatment of the mucosal form of leishmaniasis without response to glucantime, with liposomal amphotericin B. Rev Soc Bras Med Trop 1997; 30:125-128.
• 3. Lambertucci JR, Silva LC. Mucocutaneous leishmaniasis treated with liposomal amphotericin B. Rev Soc Bras Med Trop 2008; 41:87-88.

Publication Dates

• Publication in this collection
  13 Sept 2010
• Date of issue
  Aug 2010