Cutaneous Leishmaniasis of the Eyelid: A Case Report

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