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
Images in Dermatology
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
Media and news
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
Images in Dermatology
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
Media and news
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:

Quiz
87 (
2
); 300-302
doi:
10.4103/ijdvl.IJDVL_226_19
pmid:
31793498

Impressive reddish nodules with neoplastic-like appearance in a patient with Alzheimer’s disease

Department of Mental Retardation, Unit of Dermatology, Oasi Research Institute-IRCCS, Troina,
Department of Human Pathology, University of Messina, Messina, Italy

Corresponding author: Dr. Carmelo Schepis, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy. cschepis@oasi.en.it

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, tweak, 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: Siragusa M, Lentini M, Schepis C. Impressive reddish nodules with neoplastic-like appearance in a patient with Alzheimer’s disease. Indian J Dermatol Venereol Leprol 2021;87:300-2.

A deaf–mute, 71-year-old woman with Alzheimer’s disease was referred to us who presented with a voluminous left zygomatic reddish neoplastic-like lesion, with hard elastic consistency, well-defined edges and irregular ulcer covered with a thick blackish crust. Another similar smaller lesion, with a large brownish central scale, covered partially the left nasal pyramid, extending up to the inner canthus of the eye [Figure 1a]. The lesions had appeared approximately 5 months earlier. At first, none of the family members had paid any attention to them, considering the management of the behavioral disorder of the patient to be most important. The family doctor, who was consulted after a month, in consideration of the patient’s Alzheimer’s disease, hypothesized a self-injurious process and prescribed oral and topical antibiotic therapy for 1 week, without any benefit. For this reason, a dermatologist was later consulted, who diagnosed the condition as acute dermatitis and prescribed oral steroid therapy, which did not reduce the size of the lesions; instead they continued to grow with an even accelerated rate. The increasing size of the lesions worsened the psychomotor agitation of the patient; therefore, another dermatologist was consulted who confirmed acute dermatitis and administered intralesional steroid therapy with triamcinolone acetonide, once per week for 3 weeks, which only accentuated the neoplastic-like aspect of the lesions. At this clinical stage, the patient’s psychomotor agitation was uncontrollable, causing serious problems for her safety and making admission to our institute necessary.

Left zygomatic reddish neoplastic-like lesion
Figure 1a:
Left zygomatic reddish neoplastic-like lesion

The anamnesis, collected from family members, disclosed that the patient had never presented self-injurious behavior, and the inspection of the face, trunk and limbs did not show self-inflicted lesions. A 3-mm diameter biopsy from the larger lesion was then obtained which showed epidermal hyperplasia with acanthosis and mild parakeratosis. The papillary dermis showed ectatic vessels, extravasation of erythrocytes and variable numbers of neutrophils. In the mid dermis, a massive infiltrate of lymphocytes and parasitized macrophages could be seen [Figure 1b]. The parasites were round to oval, 2- to 4-nm basophilic, non-capsulated structures with eccentrically located kinetoplasts. The morphological details of endocellular amastigotes were better seen on Giemsa stain [Figure 1c].

Biopsy of the lesions showing in the mid dermis, a massive infiltrate of lymphocytes and parasitized macrophages (H and E, ×200)
Figure 1b:
Biopsy of the lesions showing in the mid dermis, a massive infiltrate of lymphocytes and parasitized macrophages (H and E, ×200)
Parasites in form of round to oval, 2 to 4nm basophilic, non capsulated structures (Giemsa stain preparation, ×400)
Figure 1c:
Parasites in form of round to oval, 2 to 4nm basophilic, non capsulated structures (Giemsa stain preparation, ×400)

What Is Your Diagnosis?

Diagnosis

Atypical cutaneous leishmaniasis.

Discussion

We treated the lesions with intralesional injection of meglumine antemoniate, 1.5 mL/week. The diagnosis was also supported by the at-risk environment in which the patient lived (home was in a bad state, with cracks on the walls, surrounded by uncultivated vegetation where many stray dogs roamed). After 3 months of treatment, the patient was clinically healed [Figure 1d]; at a 1-year follow-up, the lesions had not recurred.

Facial appearance after 3 months of treatment
Figure 1d:
Facial appearance after 3 months of treatment

Cutaneous leishmaniasis usually manifests itself with one single lesion, the so-called “Oriental sore,” located over the uncovered areas of the face. However, it is possible to observe additional lesions provoked by simultaneous or successive bites of phlebotomine sandfly, the insect that inoculates Leishmania, and this happens, above all, in patients living in endemic areas, as our patient did.1 In the literature, it is well known that cutaneous leishmaniasis can also manifest itself in atypical forms depending on the anatomical site, type of Leishmania species, delayed diagnosis, incorrect treatment (corticosteroids), or immunological status.1-4 We have published earlier a case of cutaneous leishmaniasis on the face and scalp, mimicking sebopsoriasis, in an immunosuppressed patient who was predisposed to psoriasis.3

In this new patient, the lesions did not, unfortunately, receive enough attention because of Alzheimer’s disease and above all, they received a wrong diagnosis and were subjected to incongruous therapies. We report this case to underline the necessity of prevention with an effective control of the vector (phlebotomine sandfly) and personal protection in endemic areas. It is important to remind the importance for dermatologists to correctly diagnose cutaneous leishmaniasis, especially in endemic areas. These measures should serve to avoid aberrant clinical forms with, sometimes pervasive, psychological and neurological repercussions in the most fragile patients, as in the case of our patient who was suffering from Alzheimer’s disease.

Acknowledgment

Special acknowledgments for this article are due to Mrs. Eleonora Di Fatta for her valuable assistance in the translation, preparation and formatting of the text.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , , . Leishmaniosi cutanea atipica-Un interessante caso clinico. G Ital Dermatol Venereol. 2002;137:353-8.
    [Google Scholar]
  2. , , , , , , et al. Atypical presentations of cutaneous leishmaniasis: A systematic review. Acta Trop. 2017;172:240-54.
    [CrossRef] [PubMed] [Google Scholar]
  3. , , , . Chronic cutaneous leishmaniasis mimicking sebopsoriasis. Acta Derm Venereol. 1998;78:231.
    [CrossRef] [PubMed] [Google Scholar]
  4. , , , , . Cutaneous leishmaniasis: An atypical case. Int J Dermatol. 2005;44:38-40.
    [CrossRef] [PubMed] [Google Scholar]

Fulltext Views
3,708

PDF downloads
2,550
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections