Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Case Letter
ARTICLE IN PRESS
doi:
10.25259/IJDVL_272_2022

Auricular cutaneous leishmaniasis: An unusual presentation of Leishmania major from Southwest Iran

Department of Dermatology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Department of Microbiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Department of Otolaryngology and Head and Neck Surgery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Corresponding author: Dr. Reza Yaghoobi, Department of Dermatology, Imam Khomeini Hospital, Azadegan Street, Ahvaz, Iran. yaghoobi_rz@yahoo.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Yaghoobi R, Pazyar N, Rafiei A, Saki N. Auricular cutaneous leishmaniasis: An unusual presentation of leishmania major from Southwest Iran. Indian J Dermatol Venereol Leprol, doi: 10.25259/IJDVL_272_2022

Dear Editor,

Cutaneous leishmaniasis is an infectious disease caused by anthroponotic and zoonotic species of the Leishmania genus. Leishmania major, a zoonotic species, is the major causative agent in many rural areas of the Islamic Republic of Iran, being reported from 17 out of 31 provinces, including Khuzestan. 1 Khuzestan province, located in Southwest Iran, is endemic for leishmaniasis. Although the lesions of cutaneous leishmaniasis appear mostly on the exposed regions of the body, auricular involvement is relatively rare. 2,3 Clinically, the involvement of ears, especially in Mexico, is named chiclero’s ulcer. 3

A 41year-old-man was referred to our department from the ear, nose and throat (ENT) department after 12 days of hospitalization with a clinical diagnosis of bacterial perichondritis. The erythematous, edematous inflamed left auricle had not responded to topical and systemic antibiotics over two weeks. The lesion appeared as a red nodule on the concha of the left ear and gradually increased in size over 6 months. The patient denied any trauma to his left ear. A physical examination revealed a verrucous, crusted and mildly tender mass that involved the concha, antihelix and fossa of the left ear. The helix also showed an erythematous swelling, but the other parts of the ear were unaffected [Figure 1]. No cervical lymphadenopathy or organomegaly was detected. Clinically, cutaneous leishmaniasis was suspected, and to confirm the diagnosis, a direct smear from the ear lesion was performed which showed amastigotes on Giemsa staining consistent with a diagnosis of leishmaniasis [Figure 2]. Polymerase chain reaction (PCR) revealed Leishmania major to be the causative agent. All routine laboratory tests and chest X-ray were normal. The patient received meglumine antimoniate (Glucantime, Aventis, Haupt Pharma Livron, France) intralesionally every week. All injections were painless and easy to inject. There was complete resolution without any deformity after 14 injections, and no recurrence or local or systemic complications were seen after 5 months of follow up [Figure 3].

Figure 1:
Auricular cutaneous leishmaniasis: erythematous, edematous verrucous crusted plaque over the left ear
Figure 2:
Giemsa staining showing Leishmania amastigotes inside the histiocytes (Giemsa ×1000)
Figure 3:
Complete cure of the auricular cutaneous leishmaniasis after receiving 14 intralesional injections of meglumine antimoniate

Leishmaniasis is a protozoal infection clinically characterised by a variety of skin lesions that mostly occur on the exposed parts of the body, especially the face and extremities. The diverse morphology of cutaneous lesions depends on the Leishmania species and the host immunity. 4 The epidemiology of leishmaniasis is varied in different parts of the world. In the Mediterranean region, in contrast to Mexico, involvement of the ear is reported infrequently. 2,3 Leishmaniasis of the ear, commonly seen in Mexico, is known as chiclero’s ulcer. 3 The term “chiclero” (derived from Chilce, a material collected by loggers to produce rubber) is used since the disease frequently affects loggers. 3 In Mexico, most chiclero ulcers are caused by Leishmania mexicana. 3

Leishmaniasis has a long history in Iran. In our case, the causative agent was Leishmania major. Of the 31 provinces, 17, including Khuzestan, located in the Southwest of Iran, are endemic for Leishmania major. 1 Youssef et al. previously reported a case of chiclero’s ulcer from Syria in which the causative agent was Leishmania tropica. 3 Thus, the presentation of leishmaniasis as chiclero’s ulcer may not be species dependent but possibly may vary depending on the epidemiology variations in different parts of the world. Clinically, a differential diagnosis of chiclero’s ulcer is necessary because sometimes this lesion imitates other entities, such as bacterial perichondritis, angiolymphoid hyperplasia with eosinophilia and squamous cell carcinoma. 2,3

Although there are some alternative treatments, pentavalent antimonials are the first-line treatment for all forms of leishmaniasis. 5 Our patient received intralesional meglumine antimoniate (glucantime) weekly without any significant pain. The intralesional injection of meglumine antimoniate in the ear lesion, in contrast to the cutaneous leishmaniasis lesions of the other sites, is painless and easy to perform.

Declaration of patient consent

The patient’s consent was not required as his/her identity was not disclosed or compromised.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , , , , , , et al. Epidemiological status of leishmaniasis in the Islamic Republic of Iran, 1983–2012. East Mediterr Health J. 2015;21:736-42.
    [CrossRef] [PubMed] [Google Scholar]
  2. , , , , , , et al. Auricular leishmaniasis mimicking squamous cell carcinoma. J Laryngol Otol. 2009;123:915-8.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , , , . Chiclero’s ulcer: An unusual presentation of Leishmania tropica in Syria. Avicenna J Med. 2018;8:117-9.
    [CrossRef] [PubMed] [PubMed Central] [Google Scholar]
  4. , , , . Old word leishmaniasis on the ear lobe: A rare site. Actas Dermosifiliogr. 2014;105:628-30.
    [CrossRef] [PubMed] [Google Scholar]
  5. , , , , , . Glucantime efficacy in the treatment of zoonotic cutaneous leishmaniasis. Southeast Asian J Trop Med Public Health. 2011;42:502-8.
    [PubMed] [Google Scholar]

Fulltext Views
779

PDF downloads
1,334
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections