In vivo reflectance confocal microscopic imaging of Leishmania amastigotes (Leishman bodies): A case report

Abstract

Cutaneous leishmaniasis (CL) is an intracellular parasitic infectious skin disease with a chronic self‐limited course. In vivo reflectance confocal microscopy (RCM) findings in CL have been described in only two cases of CL. We report another case with RCM findings; however to our knowledge, this is the first demonstration of Leishmania amastigotes in RCM imaging. A centrally eroded reddish nodular lesion with a diameter of 12 mm was observed on the leg of a 36‐years‐old male with a 1‐month history. On dermoscopy, a central yellowish crust, and irregularly distributed whitish opaque structures ranging in size and shape (round to polygonal) were observed. There were also irregular vessels mostly at the center and dotted/glomerular vessels at the periphery. On RCM, mild epidermal disarray with some scattered bright cells at the basal layer was observed. At the dermis, dense infiltration of polymorphic/roundish cells with heterogeneous reflectivity was seen. These large, mildly reflecting cells with fine granular structures in their cytoplasm were compatible with macrophages. Histopathology was concordant with CL. The Leishmania amastigotes seen as cytoplasmic granularity on RCM were the clue feature for the initial diagnosis.

Dermoscopy of skin parasitoses, bites and stings: a systematic review of the literature

“…2j,k) was first described by Llambrich et al ., 66 with several other studies being published afterwards 67–70 . The most frequent dermoscopic findings include diffuse erythema and vessels showing a polymorphic pattern (combination of two or more different types of vessels) 66–79 . Possible vascular shapes are irregular‐linear, arborizing, hairpin, glomerular, dotted, crown‐like, strawberry‐like, comma and corkscrew, with the first three being the most frequent morphologies 66–79 .…”

“…Although reported less frequently, white/yellow follicular plugs with a roundish, oval, or teardrop shape (often reported as ‘yellowish tears’), histologically related to follicular hyperkeratosis and peripheral radiating striae (often referred as white starburst‐like pattern), resulting from hyperkeratosis, have been described as the most peculiar features of CL 66–79 …”

“…Possible vascular shapes are irregular‐linear, arborizing, hairpin, glomerular, dotted, crown‐like, strawberry‐like, comma and corkscrew, with the first three being the most frequent morphologies 66–79 . A perivascular white halo has been often reported and correlated with epidermal acanthosis on histology 66–79 …”

“…[67][68][69][70] The most frequent dermoscopic findings include diffuse erythema and vessels showing a polymorphic pattern (combination of two or more different types of vessels). [66][67][68][69][70][71][72][73][74][75][76][77][78][79] Possible vascular shapes are irregular-linear, arborizing, hairpin, glomerular, dotted, crownlike, strawberry-like, comma and corkscrew, with the first three being the most frequent morphologies. [66][67][68][69][70][71][72][73][74][75][76][77][78][79] A perivascular white halo has been often reported and correlated with epidermal acanthosis on histology.…”

“…[66][67][68][69][70][71][72][73][74][75][76][77][78][79] Although reported less frequently, white/yellow follicular plugs with a roundish, oval, or teardrop shape (often reported as 'yellowish tears'), histologically related to follicular hyperkeratosis and peripheral radiating striae (often referred as white starburst-like pattern), resulting from hyperkeratosis, have been described as the most peculiar features of CL. [66][67][68][69][70][71][72][73][74][75][76][77][78][79] Additional dermoscopic findings described in the literature include yellow/orange/salmon ovoids/structureless areas, hyperkeratosis, yellow/white scaling, central erosion/ulceration, crusting, thrombotic vessels, yellowish hue, white scarring areas, milia-like cysts and pustules. [66][67][68][69][70][71][72][73][74][75][76][77][78][79][80] Interestingly, some studies have also evaluated dermoscopic findings according to site and duration of lesions, …”