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Revista da Sociedade Brasileira de Medicina Tropical

versão impressa ISSN 0037-8682versão On-line ISSN 1678-9849

Rev. Soc. Bras. Med. Trop. vol.52  Uberaba  2019  Epub 14-Out-2019

http://dx.doi.org/10.1590/0037-8682-0349-2019 

Images in Infectious Diseases

Disseminated cutaneous leishmaniasis: A case report

Bruna Anjos Badaró1 
http://orcid.org/0000-0001-6216-6426

Lucia Martins Diniz1 

1Universidade Federal do Espirito Santo, Hospital Universitário Cassiano Antônio Morais, Serviço de Dermatologia, Vitória, ES, Brasil.


This case report concerns a 48-year-old male patient. The patient presented with a papular, erythematous lesion that included ulcerative evolution in the left forearm and asymptomatic acneiform lesions on the left arm, face, and nasal mucosa (Figure A and Figure B). Histopathological examination revealed squamous epithelium of the follicles permeated by inflammatory cells, predominantly plasma cells. This examination suggested disseminated cutaneous leishmaniasis (DCL). The correlation between clinical and epidemiological data indicated DCL. Laboratory test results, including those for HIV testing, were negative. The patient was treated with pentavalent antimony and was reassessed after a 12-month follow up (Figure C).

FIGURE A: Acneiform lesions on the face and left arm. Presence of lesions with raised edges and surrounded by erythema on the face. 

FIGURE B: Acneiform lesions on the face. 

FIGURE C: After treatment with pentavalent antimonials. Presence of some atrophic scarring lesions on the face and left arm. 

DCL has a low incidence1-3. It is observed in up to 2% of American tegumentary leishmaniasis cases and is predominantly caused by Leishmania braziliensis1. DCL affects the face, limbs, and trunk1,2. The clinical presentation is characterized by acneiform eruption, with or without erosion/ulceration2. Involvement of the nasal mucosa is present in 53% of the cases2,3.

Diagnosis is clinical and epidemiological and can be confirmed in the laboratory. The histopathological examination indicates nodular infiltration of lymphocytes and plasma cells in the dermis, with rare macrophages and parasites3.

Direct examination of the lesion may allow observing the parasite, though rarely. The Montenegro test is positive in 83% of cases, and serology indicates increased anti-Leishmania antibodies1,3. Molecular markers help track distinct DCL strains2.

This form of leishmaniasis should be diagnosed promptly to commence treatment as soon as possible, thus blocking the dissemination of the parasite and avoiding sequelae.

Acknowledgments

To the professors, fellow residents, and patients of the Dermatology Service of the Hospital Universitário Cassiano Antônio Moraes.

REFERENCES

1. Ministério da Saúde (MS). Secretaria de Vigilância em Saúde. Manual de vigilância da leishmaniose tegumentar. 1ª edição. Brasília: MS; 2017. 191 p. [ Links ]

2. Machado GU, Prates FV, Machado PRL. Disseminated leishmaniasis: clinical, pathogenic, and therapeutic aspects. An Bras Dermatol. 2019;94(1):9-16. [ Links ]

3. Veronesi R, Focaccia R. Tratado de Infectologia. 5th ed. Rio de Janeiro: Atheneu; 2015. 2489 p. [ Links ]

Recebido: 16 de Julho de 2019; Aceito: 06 de Setembro de 2019

Corresponding author: Bruna Anjos Badaró. e-mail:brunaanjosbadaro@hotmail.com

Conflict of Interest: The authors declare that there is no conflict of interest.

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License