Cutaneous and Mucocutaneous Leishmaniasis Resembling Borderline-tuberculoid Leprosy: A New Clinical Presentation?

Abstract

Both cutaneous and mucocutaneous leishmaniasis are endemic in Northern Ethiopia. The different clinical presentations depend on the responsible organism and the host's immune response. Localized cutaneous leishmaniasis is the type most frequently seen. Diffuse cutaneous leishmaniasis is relatively rare and usually associated with mucous membrane involvement. Diffuse cutaneous leishmaniasis presents with multiple lesions, can be difficult to diagnose and responds less favourably to treatment. We report here 2 patients with unusual presentations of diffuse cutaneous leishmaniasis presenting with large hypopigmented skin lesions mimicking borderline-tuberculoid leprosy. To our knowledge this presentation has not been described before and may present difficulties in making a definite diagnosis in regions where both leprosy and cutaneous leishmaniasis are endemic. Lepromatous leprosy and diffuse cutaneous leishmaniasis are regularly confused, particularly when no skin smears for acid-fast bacillus or Leishman-Donovan bodies are performed.

Lip leishmaniasis: a case series with molecular identification and literature review

“…Accordingly, clinical diagnosis of lip leishmaniasis is frequently a challenge with a significantly delayed diagnosis or even an erroneous clinical diagnosis of malignancy [12, 19, 25]. The most important diseases that must be taken into account in differential diagnosis are herpes labialis [26], syphilitic chancre [27], Melkersson-Rosenthal syndrome [28], orofacial granulomatosis [28], cheilitis granulomatosa [29, 30], Wegener granulomatosis [12, 19, 25], oral Crohn’s disease [31], sarcoidosis [32, 33], skin tuberculosis [34], discoid lupus erythematosus [34], lymphoma [34], foreign body giant cell granuloma [12, 19, 25, 28], leprosy [35], mycotic infection [36], fibroma, lipoma, and neuroma [37], basal cell carcinoma [38], and squamous cell carcinoma [34, 39]. The diagnosis is easier to make if typical CL lesions are present elsewhere on the skin.…”

Cost-effectiveness of prevention strategies for American tegumentary leishmaniasis in Argentina

“…Therefore, we used the value associated with the disability produced by leprosy. Both conditions display similar spectra of disease phenotypes, which are dependent on T cell-mediated immunity 21 and produce similar symptoms as those seen in nasal mucosa 22,23,24 . The use of this disability weight was mentioned by Reithinger & Coleman 25 in their investigation on cost effectiveness of an operational program Table 2 Costs for treatment of patients, early diagnosis and prevention strategies.…”

“…Although attempts were made to consider the most relevant costs associated with each strategy in all scenarios, capital costs and depreciation of capital assets, since purchase of laboratory equipment, hospital or healthcare center infrastructure costs were not included. Finally, as there were no estimations available about the DALY associated with mucocutaneous leishmaniasis, we used the value associated with the disability produced by leprosy, as both conditions have similar clinical presentation and are regularly confused 22,23,24 . Changing the health outcome could have led to mistakes in the value of DALY associated with mucocutaneous leishmaniasis.…”

Leishmaniasis recidivans in Ethiopia: cutaneous and mucocutaneous features

“…Our patients all came from the Ethiopian highlands around Mekelle. It has been demonstrated that CL on the Ethiopian highlands (> 2,000 meters) is caused by L. aethiopica, which was the only species isolated from patients living in the highlands of different regions including Tigray in several studies [16][17][18][19][20][21].…”

“…No lesions were found on the body on further clinical examination. This ruled out a possible relapse of DCL, another uncommon clinical variant, which is also found in northern Ethiopia [21].…”