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Unusual presentation of cutaneous leishmaniasis
Lahiry Anup Kumar
Indian Journal of Dermatology, Venereology and Leprology , 2002,
Abstract: Cutaneous leis hmaniasis is endemic in some regions of Saudi Arabia. A case with uncommon hyperkeratotic type of lesion was seen. Being an endemic zone, a slit- skin smear was done and stained with Giemsa′s stain. Smears howed Leishman Donovan bodies within and outside the macrophages. Significant improvement, followed by complete resolution of the lesion was seen with ketoconazole treatment.
Cutaneous Leishmaniasis of the Eyelid: A Case Report  [PDF]
Jamshid Ayatollahi,Ali Ayatollahi,Seyed Hossein Shahcheraghi
Case Reports in Infectious Diseases , 2013, DOI: 10.1155/2013/214297
Abstract: Cutaneous leishmaniasis is endemic in certain areas of Iran, and in recent years, there has been an increase in the number of reports for rare and new forms of cutaneous leishmaniasis. We describe one unusual clinical form of cutaneous leishmaniasis. In a 27-year-old man, who noted a pimple on the upper eyelid 4 months before. The lesion was nodular and measured 1?cm?× 1?cm in diameter. A diagnosis of eyelid cutaneous leishmaniasis was made, and treatment was started with intramuscular meglumine antimonate. He showed a dramatic response, and the lesion almost completely disappeared. 1. Introduction Cutaneous leishmaniasis is a common protozoal disease and an important public health problem in Iran [1]. Cutaneous Leishmaniasis is a zoonotic disease caused by the Leishmania spp., and transmission occurs through the bite of a female sandfly infected with Leishmania parasites [2]. The Leishmania spp. may produce several clinical syndromes. Cutaneous leishmaniasis is the most common form, and the initial lesion is a nodule at the bite site by an infected sandfly. Fever or pain is not a feature of ulcer. We describe an unusual site of infection, eyelid cutaneous leishmaniasis. The patient was from the Yazd province, which is in the center of Iran. 2. Case Report A 27-year-old man from center of Iran noted a small pimple on eyelid 4 months before presentation. The eyelid lesion enlarged slowly. It was as a well-defined, firm, nontender, and subcutaneous skin-colored nodule. The lesion measured 1?cm × 1?cm in diameter (Figure 1). Figure 1: The lesion of eyelid on right eye. The lesion had been enlarging slowly and had slightly erythematous, raised borders and was crusty and painless. CBC (complete blood cell count), ESR (erythrocyte sedimentation rate), CRP (C-reactive protein), and blood chemistries gave results within normal limits. Sample culture of the lesion grew Staphylococcus aureus. Various treatments with cephalexin, cloxacillin, amoxicillin-claulanate, and steroids failed to heal the lesion. These treatments were performed for 10 days Although there was cutaneous leishmaniasis in the patient’s residence, and also because lack of response to treatment, cutaneous leishmaniasis or basal cell carcinoma was proposed as a differential diagnosis for him. A slit-skin smear was taken from the edge of the nodule before a biopsy could be taken. Giemsa stain of the sample showed numerous leishman bodies within the macrophages (Figure 2), and the diagnosis of cutaneous leishmaniasis was confirmed. The patient was treated with meglumine antimonate (glucantime) in a
Cutaneous infection with Mycobacterium fortuitum : An unusual presentation
Sarma S,Thakur R
Indian Journal of Medical Microbiology , 2008,
Abstract: Cutaneous infection with rapidly growing mycobacteria is uncommon and its diagnosis can be missed unless there is strong clinical suspicion coupled with microbiological confirmation. We report a case of localized recurrent soft tissue swelling of the foot by Mycobacterium fortuitum in a healthy adult male. The case is being reported for its uncommon clinical presentation and the associated etiological agent. The patient recovered completely following therapy with amikacin and clarithromycin.
Cutaneous T-Cell Lymphoma : An Unusual Presentation  [cached]
Joshi Arun,Sah Shatrughan P,Rani Sudha,Kalra O P
Indian Journal of Dermatology , 2002,
Abstract: A 38 year old Nepalese man presented with a large red tender plaque on his back of 15 days duration. He had a history of fever, cough, chest pain and haemoptysis for 4 months. On examination, he also had pallor lymphadenopathy and hepatomegaly. Investigations revealed anaemia, marked leucocytosis with 45% atypical cells and thrombocytopenia. Chest X-ray showed consolidation and bone marrow examination revealed abnormal cells. Skin biopsy had features of cutaneous T-cell lymphoma (CTCL). We report this rare presentation of CTCL with simultaneous visceral and haematological involvement.
Unusual Clinical Presentation of Cutaneous Angiosarcoma Masquerading as Eczema: A Case Report and Review of the Literature  [PDF]
Nhat Q. Trinh,Issra Rashed,Kelli A. Hutchens,Aileen Go,Edward Melian,Rebecca Tung
Case Reports in Dermatological Medicine , 2013, DOI: 10.1155/2013/906426
Abstract: An unusual case of cutaneous angiosarcoma clinically mimicking eczema is described. A 98-year-old Caucasian male presented with a 6-month history of a flesh-colored, subcutaneous nodule on his left forehead with contralateral facial erythema and scaling that had been previously diagnosed as eczema. Despite treatments with topical steroids and moisturizers, the condition did not resolve. At our clinic, excisional biopsy of the forehead lesion and scouting biopsies from the contralateral cheek were performed which revealed cutaneous angiosarcoma. The described case illustrates that dermatitis-like features should be considered as a rare clinical manifestation of cutaneous angiosarcoma. It also demonstrates that these lesions may respond well to radiotherapy as a single modality. 1. Introduction Angiosarcoma is a highly invasive tumor of vascular endothelial origin with poor prognosis and high rates of recurrences; therefore, early detection is essential to its treatment. The following case is reported because of the unusual clinical presentation of the malignant tumor in an elderly patient. 2. Case Report In early 2012, a 98-year-old robust Caucasian male presented to our clinic with a 6-month history of an enlarging flesh-colored nodule on his forehead. Following the development of this lesion, mildly pruritic red, scaly patches appeared on the right side of his face. A clinical diagnosis of eczema was rendered by an outside physician. For his presumed dermatitis, a course of therapy including topical hydrocortisone and moisturizers was prescribed. While he complied with the outlined regimen, his symptoms did not improve. On clinical examination, the patient was found to have a flesh-colored subcutaneous nodule measuring ?cm in diameter on his left forehead and poorly demarcated red, scaly patches which were most prominent on the right contralateral cheek (Figure 1). An excisional biopsy was performed, which revealed angiosarcoma with positive lateral and deep margins (Figure 2). Immunohistochemical stains showed that the tumor cells were positive for CD34 and CD31 and negative for S100, LCA, CK7, and CK20. A wider local excision was attempted; however, we were not able to achieve clear margins. The majority of the wound was closed primarily, but the central area was left to heal secondarily. Figure 1: Clinical presentation of the patient with angiosarcoma prior to treatment. Figure 2: The main tumor was bulky and composed of atypical and pleomorphic spindle cells with numerous mitotic figures (a). On the periphery of the tumor, areas of vessel formation
Many faces of cutaneous leishmaniasis  [cached]
Bari Arfan Ul,Rahman Simeen
Indian Journal of Dermatology, Venereology and Leprology , 2008,
Abstract: Background: Cutaneous leishmaniasis (CL) is known for its clinical diversity and increasing numbers of new and rare variants of the disease are being reported these days. Aim: The aim of this descriptive study was to look for and report the atypical presentations of this common disease occurring in Pakistan. Methods: The study was carried out in three hospitals (MH, Rawalpindi; PAF Hospital, Sargodha; and CMH, Muzaffarabad) from 2002 to 2006. Military and civilian patients of all ages, both males and females, belonging to central and north Punjab province and Kashmir were included in the study. Clinical as well as parasitological features of cutaneous leishmaniasis were studied. The unusual lesions were photographed and categorized accordingly using simple descriptive statistics. Results: Out of 718 patients of cutaneous leishmaniasis, 41 (5.7%) had unusual presentations. The commonest among unusual morphologies was lupoid leishmaniasis 14 (34.1%), followed by sporotrichoid 5 (12.1%), paronychial 3 (7.3%), lid leishmaniasis 2 (4.9%), psoriasiform 2 (4.9%), mycetoma-like 2 (4.9%), erysipeloid 2 (4.9%), chancriform 2 (4.9%), whitlow 1 (2.4%), scar leishmaniasis 1 (2.4%), DLE-like 1 (2.4%), ′squamous cell carcinoma′-like 1 (2.4%), zosteriform 1 (2.4%), eczematous 1 (2.4%), verrucous 1 (2.4%), palmar/plantar 1 (2.4%) and mucocutaneous 1 (2.4%). Conclusion: In Pakistan, an endemic country for CL, the possibility of CL should be kept in mind while diagnosing common dermatological diseases like erysipelas, chronic eczema, herpes zoster, paronychia; and uncommon disorders like lupus vulgaris, squamous cell carcinoma, sporotrichosis, mycetoma and other deep mycoses.
Post - Kala - Azar - dermal - leishmaniasis: An unusual presentation from Uttarachal (A non - endemic hilly region of India)  [cached]
Joshi Arun,Gulati Archana,Pathak V,Bansal Rani
Indian Journal of Dermatology, Venereology and Leprology , 2002,
Abstract: A 26 -year-old male resident of Uttaranchal had a single large, erythematous, indurated verrucous plaque on chin of 1 year duration. He had suffered from visceral leishmaniasis 4 -years back for which he was treated with injection sodium antimony gluconate (SAG) IM OD for 20 days. He had never been to regions endemic for kola - czar (KA) or post - kola -azar-dermal leishmaniasis (PKDL). Skin biopsy showed chronic granulomatous inflammation in the dermis. Giemsa stain revealed LD bodies inside the macrophages. The patient was treated successfully with injection SAG 20 mg/kg parenterally for 60 days. To the best of our knowledge, this is probably the first case of PKDL from the hills of Uttaranchal.
Isolated Laryngeal Leishmaniasis in Immunocompetent Patients: An Underdiagnosed Disease  [PDF]
Salvatore Cocuzza,Alessio Strazzulla,Marilia Rita Pinzone,Stefano Cosentino,Agostino Serra,Rosario Caltabiano,Salvatore Lanzafame,Bruno Cacopardo,Giuseppe Nunnari
Case Reports in Infectious Diseases , 2013, DOI: 10.1155/2013/165409
Abstract: We describe a case of isolated primary laryngeal leishmaniasis in an immunocompetent Italian patient with a previous medical history negative for visceral or cutaneous leishmaniasis, presenting with hoarseness. We also summarize the epidemiological, clinical, and diagnostic features and the therapeutic management of other cases of laryngeal leishmaniasis in immunocompetent subjects, described in the literature. Considering the insidious and nonspecific clinical presentation, the increasing number of different forms of mild or underestimated immunosuppressive conditions, and the number of people travelling in endemic zones, along with the ability of Leishmania amastigotes to survive for a long period in the body, we believe it is important for pathologists and clinicians to be aware of this unusual form of leishmaniasis in order to avoid delayed recognition and treatment. The rarity of the presentation and the lack of guidelines on mucosal leishmaniasis may contribute to the potential undiagnosed cases or delayed diagnosis, the possible relapses, as well as the correct pharmacological and/or surgical therapeutic approach. 1. Introduction Leishmaniasis is a zoonosis caused by protozoa of the genus Leishmania [1] and normally transmitted by the bite of the female Phlebotomus (and Lutzomiya) sandfly [2]. Extent and localization of lesions depend both on parasite characteristics and host immune response. Leishmaniasis can be clinically classified into three forms: cutaneous leishmaniasis (CL), visceral leishmaniasis (VL), and mucosal/mucocutaneous leishmaniasis (ML) [3]. In leishmaniasis, larynx is more often involved during ML, when mucosal lesions, firstly localized in the nose and/or oral cavity, may progressively descend the upper respiratory tract and sometimes involve the laryngeal mucosa. This is typical of Leishmania (L) braziliensis infection, which is common in South America [4]. However, some cases of primary laryngeal leishmaniasis, without previous or contemporary involvement of other sites, have been reported. These reports have been associated with L. donovani and L. infantum infection, which are typical of the Mediterranean Basin, India, and Sub-Saharan Africa [2]. Here, we present a case of primary isolated laryngeal leishmaniasis in an immunocompetent Italian patient and a review of the literature. 2. Case Presentation In July 2010, a 64-year-old Italian man presented to the Division of Infectious Diseases of the Garibaldi-Nesima Hospital of Catania with an 8-month history of hoarseness and discomfort. He lived in Sicily and he had not
Diffuse cutaneous leishmaniasis: Co-infection with human immunodeficiency virus (HIV)  [cached]
Chaudhary Raju,Bilimoria Freny,Katare S
Indian Journal of Dermatology, Venereology and Leprology , 2008,
Abstract: Cutaneous leishmaniasis is a disease caused by intracellular protozoal parasites belonging to the genus Leishmania. Immune suppression caused by HIV infection is an important factor for atypical presentation and widespread progression of cutaneous leishmaniasis. Diffuse (disseminated) cutaneous leishmaniasis and HIV co-infection is emerging as an extremely serious new disease. A 38-year-old HIV-positive man presented with a 12-month history of a progressive papule and nodular eruptions on face and extremities with infiltrations of nasal and oral mucosa. We report the case due to its atypical, widespread muco-cutaneous presentation masquerading as lepromatous leprosy.
Treatment Approaches for Cutaneous Leishmaniasis  [PDF]
Sema Aytekin
Turkderm , 2009,
Abstract: Cutaneous leishmaniasis (CL) is a widespread tropical infection caused by numerous different species of Leishmania protozoa. In our country, CL is due frequently to L. major and L. tropica. Its clinical presentation is extremely diverse. Treatment of CL aims to prevent mucosal invasion, to accelerate the healing of skin lesions, and avoid disfiguring scar. Local and physical treatment modalities including topical paromomycin, cryotherapy, localized controlled heat, carbon dioxide laser therapy, or pentavalant antimonals can be effective against. Intralesional antimonals are still the drug of choice may patients. WHO recommends an injection of drug under edges of the lesions and the entire lesion until the surface has blanched. Parenteral antimonials are useful for large, persistent or recurrent lesions. Combinations with other drugs such as allopurinol, pentoxifylline must be used for antimony unresponsive lesions.
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