Disseminated cutaneous leishmaniasis: A case report

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 incidence^1-3. 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 trunk^1,2. The clinical presentation is characterized by acneiform eruption, with or without erosion/ulceration². Involvement of the nasal mucosa is present in 53% of the cases^2,3.

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 antibodies^1,3. 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.
• ²
  Machado GU, Prates FV, Machado PRL. Disseminated leishmaniasis: clinical, pathogenic, and therapeutic aspects. An Bras Dermatol. 2019;94(1):9-16.
• ³
  Veronesi R, Focaccia R. Tratado de Infectologia. 5th ed. Rio de Janeiro: Atheneu; 2015. 2489 p.

Publication Dates

• Publication in this collection
  14 Oct 2019
• Date of issue
  2019

History

• Received
  16 July 2019
• Accepted
  06 Sept 2019