American Cutaneous Leishmaniasis: A Pleomorphic Disease with Unusual Clinical Presentations - Report of Three Cases
Background: Cutaneous leishmaniasis (CL) is an infectious disease caused by a protozoan of the genus Leishmania and is transmitted by the anopheline mosquito. This study focused on describe three cases of atypical clinical presentations on patients with American cutaneous leishmaniasis from Dermatology Department of the State University of the State of Pará.
Methods and Findings: Three patients assisted at a referral service between 2017 and 2019 are reported, based on clinical interview, histopathological analysis and polymerase chain reaction. On the first patient, it was observed keratotic erythematous vegetative plaque measuring 10x8 cm, with satellite lesions, in the left lower limb; the second patient presented an erythematous infiltrated plaque with crusts, on left ear for 6 months, with progressive growth; the third patient showed erythematous infiltrated plaques, sometimes ulcerated, in the trunk and face, with a zosteriform aspect. All three patients had the diagnosis confirmed by polymerase chain reaction and histopathological analysis.
Conclusions: The wide range of clinical manifestations may be related to factors such as: use of immunosuppressive drugs, concomitant infections with more than one variety of Leishmania spp. and association with other systemic diseases, with HIV co-infection and diabetes being the main associated diseases. Thus, it is always necessary to evaluate such comorbidities on patients with leishmaniasis suspection, in order to avoid misdiagnosis.
2. Hernández AM, Gutierrez JD, Xiao Y, Branscum AJ, Cuadros DF. Spatial epidemiology of cutaneous leishmaniasis in Colombia: socioeconomic and demographic factors associated with a growing epidemic. Trans R Soc Trop Med Hyg [Internet]. 2019;00:1–9
3. Dominicis CN, Ferreira FR, Maria F, Rabay DO, Mandelbaum SH. Caso Clínico Leishmaniose Tegumentar Americana : Uma Doença Polimorfa American Cutaneous Leishmaniasis : A Polymorphic Disease. Rev SPDV. 2018;76(June):177–80.
4. Gupta G, Santana AKM, Gomes CM, Turatti A, Milanezi CM, Bueno Filho R, et al. Inflammasome gene expression is associated with immunopathology in human localized cutaneous leishmaniasis. Cell Immunol [Internet]. 2019;341(July):103920. Available from: https://doi.org/10.1016/j.cellimm.2019.04.008.
5. Batra D, Lin W, Narayanan V, Rowe LA, Sheth M, Zheng Y, et al. Draft Genome Sequences of Leishmania (Leishmania) amazonensis, Leishmania (Leishmania) mexicana, and Leishmania (Leishmania) aethiopica, Potential Etiological Agents of Diffuse Cutaneous Leishmanias. Microbiol Resourc Announc. 2019;8(20):1–3.
6. Serarslan G, Ekiz Ö, Özer C, Sarıkaya G. Dermoscopy in the Diagnosis of Cutaneous Leishmaniasis. Dermatol Pract Concept. 2019;9(2):111–8.
7. Mcgwire BS, Satoskar AR. Leishmaniasis: Clinical syndromes and treatment. Qjm. 2014;107(1):7–14.
8. Chakravarty J, Sundar S. Current and emerging medications for the treatment of leishmaniasis. Expert Opin Pharmacother [Internet]. 2019;20(0):1–15. Available from: https://doi.org/10.1080/14656566.2019.1609940
9. Arboleda M, Barrantes S, Úsuga LY, Robledo SM. Successful treatment of cutaneous leishmaniasis with intralesional meglumine antimoniate: A case series. Rev Soc Bras Med Trop. 2019;52(0):1–4.
10. Meireles CB, Maia LC, Soares GC, Parente I, Teodoro P, Vieira S, et al. Acta Tropica Atypical presentations of cutaneous leishmaniasis : A systematic review. Acta Trop [Internet]. 2017;172(March):240–54. Available from: http://dx.doi.org/10.1016/j.actatropica.2017.05.022.
11. AZULAY, R.D.; AZULAY, D.R.; AZULAY, L.A. Dermatologia. 6 ed., rev. e atual. Rio de Janeiro: Guanabara Koogan, 2015.
12. Nicodemo AC, Duailibi DF, Feriani D, Irma M, Duarte S, Amato VS. Mucosal leishmaniasis mimicking T-cell lymphoma in a patient receiving monoclonal antibody against TNF α. Negl Trop Dis. 2017;11(9):e0005807. Available from: https://doi.org/10.1371/journal.pntd.0005807
13. Sandoval Pacheco CM, Araujo Flores GV, Favero Ferreira A, et al. Histopathological features of skin lesions in patients affected by non- ulcerated or atypical cutaneous leishmaniasis in Honduras, Central America. Int. J. Exp. Path. 2018;00:1–9. Available from: https://doi.org/10.1111/iep.12295
14. Talat H, Attarwala S, Saleem M. Cutaneous leishmaniasis with HIV. J. Coll. Physicians Surg. 2014; Pak. 24 (Suppl 2), S93–95..
15. Lopes L, Vasconcelos P, Borges-costa J, Soares-almeida L, Campino L, Filipe P. An atypical case of cutaneous leishmaniasis caused by Leishmania infantum in Portugal. Dermatol. Online J. 2013; 19 (2): 04-07
16. Szargiki R, Castro EA, Luz E, Kowalthuk W, Machado AM, Thomaz-Soccol V. Comparison of serological and parasitological methods for cutaneous leishmaniasis diagnosis in the state of Paraná, Brazil. Braz J Infect Dis. 2009;13:47-52
17. Aronson N, Herwaldt BL, Libman M, et al. Diagnosis and treatment of leishmaniasis: clinical practice guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis 2016; 63: e202–64
18. Salmanpour R, Razmavar MR, Abtahi N. Comparison of intralesional meglumine antimoniate, cryotherapy and their combination in the treatment of cutaneous leishmaniasis. Int J Dermatol 2006; 45: 1115–16
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