Mucosal leishmaniasis mimicking squamous cell carcinoma in a liver transplant recipient

Ramos, Antonio; Múñez, Elena; García-Domínguez, J M; Martínez-Ruiz, Rocío; Chicharro, Carmen; Baños, I.; Suárez-Massa, Dolores; Cuervas-Mons, Valentín

doi:10.1111/tid.12380

Cited by 22 publications

(23 citation statements)

References 33 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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BackgroundMucocutaneous leishmaniasis (MCL), a protozoan infectious disease, is very rare in Iran despite the endemicity of both cutaneous and visceral forms. It is transmitted by the Phlebotomus sand fly. The lip is considered one of the extraordinary sites. Lesions usually initiate with erythematous papules, slowly enlarges and then it ulcerates. The diagnosis of MCL encompasses epidemiological, clinical and laboratory aspects. Usually, the combination of some of these elements is necessary for the final diagnosis. So, lip leishmaniasis lesions can be challenging to diagnose.Case presentationWe presented seven rare cases of lip leishmaniasis. Tissue impression smear, culture, PCR and phylogenetic analysis were carried out for explicit diagnosis. Skin scraping investigation showed several Leishmania spp. amastigotes in the cytoplasm of macrophages. Culture examination was positive for Leishmania spp. PCR was positive for L. major, L. tropica, and L. infantum. Differential diagnosis includes orofacial granulomatosis, basal cell carcinoma, squamous cell carcinoma, and mesenchymal tumors. The cases were treated with systemic meglumine antimoniate (Glucantime®). No relapses were observed during 1 year of follow-up. Early detection of the infection are necessary in order to start effective treatment and prevent more serious complications.ConclusionsIn this paper, we reported seven rare cases of lip leishmaniasis in Iran, emphasized the importance of clinical and diagnostic features of lesions, characterized the phylogenetic kinship of isolated parasites, and reviewed the literature on lip leishmaniasis.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2017

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“…Mucosal forms of L. infantum infection are very rare [3–5]. Concomitant or consecutive cutaneous or mucosal with visceral clinical manifestations of leishmaniasis have been seldom described.…”

Section: Introductionmentioning

confidence: 99%

Recurrence of visceral and muco-cutaneous leishmaniasis in a patient under immunosuppressive therapy

et al. 2017

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BackgroundLeishmaniasis is a protozoan disease caused by parasites of the genus Leishmania, transmitted to humans by sandflies. The diagnosis of leishmaniasis is often challenging as it mimics many other infectious or malignant diseases. The disease can present in three ways: cutaneous, mucocutaneous, or visceral leishmaniasis, which rarely occur together or consecutively.Case presentationThe patient was a 52 years old immunosuppressed Belgian woman with a long history of severe rheumatoid arthritis. She underwent bone marrow biopsy to explore thrombocytopenia. Diagnosis of visceral leishmaniasis was made by identification of Leishman Donovan (LD) bodies in macrophages. Treatment with liposomal amphotericin B was successful. She later developed cutaneous leishmaniasis treated with amphotericin B lipid complex. She next presented with relapsing cutaneous lesions followed by rapidly progressing lymphadenopathies. Biopsy confirmed the diagnosis of leishmaniasis. Treatments by miltefosine, amphotericin B, N-methyl-glucamine antimoniate were subsequently initiated. She later presented a recurrent bone marrow involvement treated with intramuscular paromomycin and miltefosine. She died two years later from leukemia. At the time of death, she presented with a mucosal destruction of the nose. A Leishmania-specific PCR (Polymerase Chain Reaction) identified L. infantum as etiological agent.ConclusionsClinicians should be aware of the potential concomitant or sequential involvement of multiple anatomic localizations of Leishmania in immunosuppressed patients.

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“…The diagnosis of both cutaneous and mucosal leishmaniasis is often delayed due to lack of suspicion . Mucosal lesions, in particular, can be confused with malignancy.…”

Section: Solid Organ Transplant Recipientsmentioning

confidence: 99%

“…56,57 Mucosal involvement with or without skin lesions has been described in only a few cases of SOT recipients. 58 It is traditionally associated with New World leishmaniasis (mainly with L. braziliensis), but viscerotropic species including L. infantum and L. donovani have also been incriminated in a number of cases. 4,16,[58][59][60][61][62][63][64][65][66] It generally involves the tongue, lips, and the oral cavity and can occur as long as >20 years after organ transplantation.…”

Section: Cutaneous and Mucocutaneous Leishmaniasesmentioning

confidence: 99%

Leishmaniasis in solid organ and hematopoietic stem cell transplant recipients

Gajurel

Dhakal

Deresinski

2016

Clinical Transplantation

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Leishmaniasis occurs in <1% of solid organ and hematopoietic stem cell transplant recipients in endemic countries in which transplants are performed. Visceral leishmaniasis (VL) makes up the bulk of reported cases. The onset generally occurs months after transplantation and the mode of acquisition is often impossible to determine, but de novo vector-borne infection and reactivation of inapparent infection are thought to be the principal means. The potential role of clinically inapparent donor infection is uncertain and screening is not currently recommended, nor is it recommended for recipients from endemic areas, some of whom may have detectable circulating protozoan nucleic acid. While transplant recipients with VL often present with the non-specific findings of fever and cytopenia, the additional presence of hepatosplenomegaly in patients from endemic areas should lead to a directed diagnostic evaluation with bone marrow examination and PCR testing of marrow and peripheral blood having a high yield. Management may often be complicated by the presence of concomitant infections. A lipid formulation of amphotericin B is the preferred treatment, especially for VL, but the relapse rate in transplant recipients is approximately 25%. PCR monitoring of blood for either secondary prophylaxis or preemptive therapy requires further study.

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Mucosal leishmaniasis mimicking squamous cell carcinoma in a liver transplant recipient

Cited by 22 publications

References 33 publications

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

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

Recurrence of visceral and muco-cutaneous leishmaniasis in a patient under immunosuppressive therapy

Leishmaniasis in solid organ and hematopoietic stem cell transplant recipients

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