Cutaneous leishmaniasis: A case report of a diagnostic dilemma

Abstract

Cutaneous leishmaniasis (CL) is the most prevalent clinical form of leishmaniasis and is caused by vector‐borne protozoan parasite. Variation in diagnostic accuracy exists. A 54‐year‐old female farmer by occupation presented with lesion over right thigh for 8 months. Lesion evolved over period of 2–3 months and progressed to form ulcer with surrounding redness. On examination, solitary plaque with crateriform ulcer 3 * 2 cm in size roughly oval in shape was present. Ulcer floor was moist, smooth shiny with serous discharge, and well‐defined raised erythematous margin was present. Biopsy was done which showed features suggestive of lupus vulgaris, for which anti‐tubercular treatment (ATT) was started. There was persistence of ulcer despite 4 months of ATT, for which diagnosis was reconsidered and fine‐needle aspiration cytology (FNAC) was performed. FNAC showed numerous intra‐ and extracellular amastigotes suggestive of leishmaniasis which was treated with complete disappearance of ulcer over 4 months.

A rare case of cutaneous leishmaniasis in Kathmandu presenting with features of bacterial skin infection: A case report

“…Choice of the test to accurately diagnose CL should be considered based on the sensitivity and specificity of a test and more importantly, on the availability. 8 This is especially more significant in a country like Nepal, where resources are limited. Early diagnosis and prompt treatment of patients with CL have been difficult due to the rare nature of the disease and nonspecific presentation.…”

“…Although Nepal is considered nonendemic for CL where most of the programs are focused on eliminating visceral leishmaniasis, it is highly imperative to consider the emergence of CL in Nepal. Choice of the test to accurately diagnose CL should be considered based on the sensitivity and specificity of a test and more importantly, on the availability 8 . This is especially more significant in a country like Nepal, where resources are limited.…”

“…This is especially more significant in a country like Nepal, where resources are limited. Early diagnosis and prompt treatment of patients with CL have been difficult due to the rare nature of the disease and nonspecific presentation 8 . The differential diagnosis of CL should be highly considered in the case of chronic, general painless lesions occurring on exposed areas of skin, especially in people living in endemic areas 9 …”

Intracellular amastigotes in fine‐needle aspiration cytology of cutaneous leishmaniasis

“…Due to similar other clinical mimics, its diagnosis is often confused with other endemic disease such as lupus vulgaris. Hence, a simple yet diagnostic technique such as FNAC will be helpful for diagnosis through identification of intracellular amastigotes in dermal macrophages of human hosts in resource poor setting of the low‐income countries 3 . Corroboration of clinical features with parasitological confirmation will defer sophisticated tests such as polymerase chain reaction (PCR) for identification of leishmanial DNA in rural parts of Nepal.…”

“…Hence, a simple yet diagnostic technique such as FNAC will be helpful for diagnosis through identification of intracellular amastigotes in dermal macrophages of human hosts in resource poor setting of the low‐income countries. 3 Corroboration of clinical features with parasitological confirmation will defer sophisticated tests such as polymerase chain reaction (PCR) for identification of leishmanial DNA in rural parts of Nepal. Hence, a simple and easily available confirmatory diagnostic test such as FNAC could be utilized in resource poor setting.…”