Skip to main content

A case report of cutaneous leishmaniasis: a misleading clinical presentation

Abstract

Background

The diagnosis of cutaneous leishmaniasis (CL) is often difficult because of the diversity of clinical presentations, its often-misleading appearance and the very long incubation period (time between the endemic stay and the onset of skin lesions).

Case

We report the case of an otherwise healthy 67-year-old man who presented with inflammatory skin lesions on the scalp and face for the past 7 years. The lesions were first mistaken as cutaneous sarcoidosis, mycobacterial infection, and cutaneous lymphoma. Finally, the diagnosis was made by RT-PCR analysis on a punch-biopsy specimen, which was positive for Leishmania infantum.

Discussion and conclusion

To date, the choice of treatment for complex cutaneous leishmaniases is based on the Leishmania species. Our patient successfully responded to liposomal amphotericin B.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. 1.

    Aronson NE, Joya CA. Cutaneous leishmaniasis: updates in diagnosis and management. Infect Dis Clin North Am. 2019;33:101–17.

    Article  Google Scholar 

  2. 2.

    Merino-Espinosa G, Corpas-López V, Díaz-Sáez V, Morillas-Márquez F, Tercedor-Sánchez J, Azaña-Defez JM, et al. Cutaneous leishmaniasis by Leishmania infantum: behind granulomatous lesions of unknown aetiology. J Eur Acad Dermatol Venereol JEADV. 2018;32:117–24.

    CAS  Article  Google Scholar 

  3. 3.

    Tyring SK, Lupi O, Hengge UR. Leishmaniasis. In: Tropical dermatology e-book. Elsevier Health Sciences, 2016, 2nd edn. https://books.google.be/books?id=_GdjDQAAQBAJ&printsec=frontcover&hl=fr#v=onepage&q&f=false. ISBN 032333914X, 9780323339148

  4. 4.

    Maroli M, Rossi L, Baldelli R, Capelli G, Ferroglio E, Genchi C, et al. The northward spread of leishmaniasis in Italy: evidence from retrospective and ongoing studies on the canine reservoir and phlebotomine vectors. Trop Med Int Health TM IH. 2008;13:256–64.

    Article  Google Scholar 

  5. 5.

    Gaspari V, Ortalli M, Foschini MP, Baldovini C, Lanzoni A, Cagarelli R, et al. New evidence of cutaneous leishmaniasis in north-eastern Italy. J Eur Acad Dermatol Venereol JEADV. 2017;31:1534–40.

    CAS  Article  Google Scholar 

  6. 6.

    del Giudice P, Marty P, Lacour JP, Perrin C, Pratlong F, Haas H, et al. Cutaneous leishmaniasis due to Leishmania infantum: case reports and literature review. Arch Dermatol. 1998;134:193–8.

    Article  Google Scholar 

  7. 7.

    Bongiorno MR, Pistone G, Aricò M. Unusual clinical variants of cutaneous leishmaniasis in Sicily. Int J Dermatol. 2009;48:286–9.

    Article  Google Scholar 

  8. 8.

    Martín-Ezquerra G, Fisa R, Riera C, Rocamora V, Fernández-Casado A, Barranco C, et al. Role of Leishmania spp. infestation in nondiagnostic cutaneous granulomatous lesions: report of a series of patients from a Western Mediterranean area. Br J Dermatol. 2009;161:320–5.

    Article  Google Scholar 

  9. 9.

    Burza S, Croft SL, Boelaert M. Leishmaniasis. Lancet Lond Engl. 2018;392:951–70.

    Article  Google Scholar 

  10. 10.

    Meireles CB, Maia LC, Soares GC, Teodoro IPP, Gadelha M do SV, da Silva CGL, et al. Atypical presentations of cutaneous leishmaniasis: A systematic review. Acta Trop. 2017;172:240–54.

  11. 11.

    Pittalis S, Nicastri E, Spinazzola F, Ghirga P, De Marco M, Grazia Paglia M, et al. Leishmania infantum leishmaniasis in corticosteroid-treated patients. BMC Infect Dis. 2006;6:177.

    Article  Google Scholar 

  12. 12.

    Castellano LR, Filho DC, Argiro L, Dessein H, Prata A, Dessein A, et al. Th1/Th2 immune responses are associated with active cutaneous leishmaniasis and clinical cure is associated with strong interferon-gamma production. Hum Immunol. 2009;70:383–90.

    CAS  Article  Google Scholar 

  13. 13.

    Aronson N, Herwaldt BL, Libman M, Pearson R, Lopez-Velez R, Weina P, 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 Off Publ Infect Dis Soc Am. 2016;63:e202–e264264.

    Article  Google Scholar 

  14. 14.

    Hodiamont CJ, Kager PA, Bart A, de Vries HJC, van Thiel PP, Leenstra T, et al. Species-Directed Therapy for Leishmaniasis in Returning Travellers: A Comprehensive Guide. PLoS NTD. 2014;8:e2823.

    Google Scholar 

  15. 15.

    Mosimann V, Neumayr A, Paris DH, Blum J. Liposomal amphotericin B treatment of Old World cutaneous and mucosal leishmaniasis: a literature review. Acta Trop. 2018;182:246–50.

    CAS  Article  Google Scholar 

Download references

Acknowledgements

We thank Laurine Sacré, MD, for referral of the patient and the pathologists, Julie Lelotte, MD, Pascal Van Eeckout, MD, and Alessandra Camboni, MD, for their contributions to this case. We thank Mariana Andrade, MD, who provided editorial assistance. Compensation but no commercial funding was received for this purpose.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Marie Baeck.

Ethics declarations

Conflicts of interest

The authors confirm that they have no conflict of interest.

Written patient consent

Obtained.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Vanlier, C., Marot, L., Laranaga, E. et al. A case report of cutaneous leishmaniasis: a misleading clinical presentation. Infection 49, 177–180 (2021). https://doi.org/10.1007/s15010-020-01517-1

Download citation

Keywords

  • Leishmaniasis
  • Skin
  • Leishmania infantum