Lupoid cutaneous leishmaniasis: a case report

Abstract

BackgroundLupoid cutaneous leishmaniasis (CL) is a rare form of CL having a striking resemblance to other granulomatous cutaneous conditions of infectious or inflammatory origin. The authors present a patient with a facial lupoid CL and discuss the diagnostic tools of this parasitological infection, the main differential diagnosis, and treatment.Case reportA 54-year-old Tunisian woman, with no past medical history of lupus erythematosus or infectious disease, presented with a 3-month history of a slowly enlarging erythematous and infiltrated plaque, extending over the nose, the right cheek, and the internal aspect of the right lower eyelid. Microscopic examination of a parasitological smear showed numerous leishmania in their amastigote form, inside monocytes, confirming the diagnosis of CL. Clinical aspect was in favor of lupoid CL. The patient was cured by fluconazole 200 mg/day for 6 weeks after pancreatic intolerance with intramuscular meglumine antimoniate (60 mg/kg/day for 7 days), and no response to doxycycline (200 mg/day for 6 weeks).DiscussionLupoid CL is easily suspected in countries in which there is an endemic of leishmaniasis. In countries where there isn’t an endemic, although rarely observed, this diagnosis should also be kept in mind in front of an infiltrated facial lesion of a tuberculoid aspect on histology, especially when there is a positive travel history to an area in which there is an endemic.

Lupoid mucocutaneous leishmaniasis

“…In the literature, L. tropica is thought to be the most frequent causative agent of lupoid CL. This form of the disease has a striking resemblance to other granulomatous cutaneous conditions of infectious or inflammatory origin [19,20]. Lupoid CL on the face resembling that of lupus vulgaris, leprosy or lupus erythematosus is frequently seen in Ethiopia nowadays.…”

“…Treatment depends on the region of the world in which the infection was acquired, the species of Leishmania, the site and severity of the infection, and host factors, such as immune status and age [21,22]. Lupoid CL is usually resistant to conventional therapies for CL and it may persist and spread slowly for many years [19]. In the absence of randomized controlled trials, there are not enough data about the proper therapeutic protocol for the treatment of lupoid CL.…”

“…Na podstawie dostępnego piśmiennictwa uznaje się, że najczęstszym czynnikiem wywołującym toczniową postać CL jest L. tropica. Postać ta wykazuje bardzo duże podobieństwo do innych ziarniniakowych schorzeń skóry o podłożu zakaźnym lub zapalnym [19,20]. Obecnie w Etiopii często stwierdza się przypadki odmiany toczniowej CL umiejscowionej na twarzy, przypominającej gruźlicę toczniową, trąd lub toczeń rumieniowaty.…”

“…The authors declare no conflict of interest. konwencjonalne metody leczenia i może utrzymywać się i rozwijać powoli przez wiele lat [19]. Ze względu na brak randomizowanych, kontrolowanych badań nie ma wystarczających danych dotyczących schematu leczniczego, który powinien być stosowany w terapii postaci toczniowej CL.…”

Leishmanioses cutanées

“…De plus, plusieurs aspects cliniques similaires sont désignés par des dénominations différentes : lupoïdes [7,8] et érysipéloïdes [9]. La Leishmania recidivans est aussi parfois décrite sous les noms de chronique ou lupoïde [10].…”