An Epidemic Outbreak of Cutaneous Leishmaniasis Presenting as Suppurative Folliculitis: A Study of 6 Cases

Abstract

Folliculitis is defined as the inflammation of the follicles. The most common cause of folliculitis is infection. Here, we report an unusual cause of suppurative infundibulitis-which had not yet been described in the literature-due to Leishmania infection, and exemplified by 6 cases that occurred in the setting of an epidemic outbreak. The 6 individuals were immigrants from Morocco. Most of them were men (4 men and 2 women), and most of them were less than 30 years old (apart from one 40-year-old woman). In all cases, a cutaneous biopsy was performed. There was a granulomatous folliculitis with suppurative granulomas in all the cases. All cases showed prominence of plasma cells in the inflammatory infiltrate, and leishmanias were found in all cases. They were mainly seen in the abscessified central areas. The amount of organisms varied from a few to a moderate amount. They were stained by the anti-CD1a antibody (Novocastra) and by a polyclonal homemade anti-leishmania antibody. In addition, in 1 case, microbiological culture was performed, and Leishmania major was demonstrated as the causative agent of the infection.

Cutaneous leishmaniasis: A pathological study of 360 cases with special emphasis on the contribution of immunohistochemistry and polymerase chain reaction to diagnosis

“…They are extremely infrequent in our series, with only two cases of the former and one of the latter. However, they have been previously reported in cutaneous leishmaniasis caused by different Leishmania species 19,20 and pathologists should be aware of their existence to avoid misdiagnosis.…”

Histopathologic features of cutaneous leishmaniasis and use of CD1a staining for amastigotes in Old World and New World leishmaniasis

“…A subsequent study on Old World disease from Spain also had 100% sensitivity ( n = 19) for CD1a positivity in amastigotes, but only examined biopsies from patients infected with L. infantum. Six additional cases were recently reported which were all CD1a (MTB1 clone) positive . Only 1 had speciation data ( L. major ).…”

Hombre de 18 años con síndrome verrugoso tropical: ¿leishmaniasis o esporotricosis?

“…En las leishmaniasis es posible ver abscesos intraepidérmicos, especialmente si hay infección secundaria. Esto sucedió en seis casos de leishmaniasis cutánea en Marruecos, en los cuales se demostraron granulomas abscedados con compromiso folicular y presencia de amastigotes en los abscesos, hallazgo este excepcional ( 9 ). Además de los granulomas abscedados en la esporotricosis, la abundancia y la prominencia de células gigantes (segunda biopsia) y la cicatriz prominente (primera biopsia), son hallazgos típicos de la esporotricosis, no de la leishmaniasis cutánea ( 1 , 2 ).…”