A rare case of lupoid leishmaniasis defying diagnosis for a decade
- PMID: 32623733
- DOI: 10.1111/cup.13793
A rare case of lupoid leishmaniasis defying diagnosis for a decade
Abstract
Cutaneous leishmaniasis (CL) is a common disease affecting millions in endemic areas worldwide. We present a case of lupoid leishmaniasis, a rare variant of CL, which clinically mimicked sarcoidosis and/or granulomatous rosacea for 10 years until ultimate diagnosis. An 82-year-old U.S. citizen with an extensive travel history presented with a 10-year history of facial plaques on the cheeks and was previously diagnosed and treated as sarcoidosis. Multiple biopsies (previously and at presentation) revealed tuberculoid granulomas with negative special stains for microorganisms and negative sterile tissue cultures for acid-fast bacilli, bacteria, and fungal organisms. A diagnosis of granulomatous rosacea was rendered and multiple medical therapies were attempted, none with sustained improvement. Repeat biopsy of a new lesion revealed intracellular organisms consistent with leishmaniasis, which was confirmed by polymerase chain reaction (PCR). Lupoid leishmaniasis is a rare presentation of CL including facial plaques that can mimic granulomatous diseases affecting the face including sarcoidosis and granulomatous rosacea. CL can sometimes be challenging to diagnose through standard histopathologic examination; immunohistochemistry for CD1a can be used to augment tissue-based examination and PCR should be sent early in cases with sufficient concern.
Keywords: Leishmania braziliensis; cutaneous leishmaniasis; lupoid.
© 2020 John Wiley & Sons A/S . Published by John Wiley & Sons Ltd.
Similar articles
-
Unusual histopathological features of cutaneous leishmaniasis identified by polymerase chain reaction specific for Leishmania on paraffin-embedded skin biopsies.Br J Dermatol. 2006 Oct;155(4):815-9. doi: 10.1111/j.1365-2133.2006.07365.x. Br J Dermatol. 2006. PMID: 16965433
-
[Chronic lupoid leishmaniasis. A rare differential diagnosis in Germany for erythematous infiltrative facial plaques].Hautarzt. 2007 Mar;58(3):256-60. doi: 10.1007/s00105-006-1129-4. Hautarzt. 2007. PMID: 16670926 German.
-
Lupoid leishmaniasis among the known cases of cutaneous leishmaniasis in Herat Province, western Afghanistan.J Infect Public Health. 2016 Sep-Oct;9(5):557-63. doi: 10.1016/j.jiph.2015.12.008. Epub 2016 Jan 13. J Infect Public Health. 2016. PMID: 26796767
-
Cutaneous leishmaniasis: A great imitator.Clin Dermatol. 2020 Mar-Apr;38(2):140-151. doi: 10.1016/j.clindermatol.2019.10.008. Epub 2019 Oct 24. Clin Dermatol. 2020. PMID: 32513395 Review.
-
Atypical presentations of cutaneous leishmaniasis: A systematic review.Acta Trop. 2017 Aug;172:240-254. doi: 10.1016/j.actatropica.2017.05.022. Epub 2017 May 17. Acta Trop. 2017. PMID: 28526427 Review.
References
REFERENCES
-
- Bolognia J, Cerroni L, Schaffer JV. Chapter 83: Protozoa and Worms. Francisco Bravo. Dermatology. Amsterdam, Netherlands: Elsevier; 2018;1470-1476.
-
- Amer M, Amer A. Rarely seen infections. Clin Dermatol. 2014;32(6):744-751.
-
- Shuman EK. Global climate change and infectious diseases. N Engl J Med. 2010;362(12):1061-1063.
-
- Zaraa I, Ishak F, Kort R, et al. Childhood and adult cutaneous leishmaniasis in Tunisia. Int J Dermatol. 2010;49(7):790-793.
-
- Sundharkrishnan L, North JP. Histopathologic features of cutaneous leishmaniasis and use of CD1a staining for amastigotes in Old World and New World leishmaniasis. J Cutan Pathol. 2017;44(12):1005-1011.
Publication types
MeSH terms
LinkOut - more resources
Full Text Sources
Medical