Generic selectors
Exact matches only
Search in title
Search in content
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 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 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
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
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 Reviews and Meta-analysis
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor - Case Letter
2017:83:1;91-93
doi: 10.4103/0378-6323.190848
PMID: 27643545

Mucocutaneous leishmaniasis with marked facial disfigurement

Ozlem Ekiz1 , Şerif Şamil Kahraman2 , Bilge Bülbül Şen1 , Gamze Serarslan1 , Emine Nur Rifaioğlu1 , Gülnaz Culha3 , Tümay Özgür4
1 Department of Dermatology, Tayfur Ata Sokmen Medical School, Mustafa Kemal University, Antakya, Hatay, Turkey
2 Department of Otolaryngology, Medical Faculty of Mustafa Kemal University, Antakya, Hatay, Turkey
3 Department of Parasitology, School of Medicine, Mustafa Kemal University, Antakya, Hatay, Turkey
4 Department of Pathology, School of Medicine, Mustafa Kemal University, Antakya, Hatay, Turkey

Correspondence Address:
Ozlem Ekiz
Department of Dermatology, Tayfur Ata Sokmen Medical School, Mustafa Kemal University, Antakya, Hatay 31000
Turkey
How to cite this article:
Ekiz O, Kahraman &&, Şen BB, Serarslan G, Rifaioğlu EN, Culha G, Özgür T. Mucocutaneous leishmaniasis with marked facial disfigurement. Indian J Dermatol Venereol Leprol 2017;83:91-93
Copyright: (C)2017 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

A 52-year-old Syrian presented to the dermatology department at Hatay Mustafa Kemal University with complaints of facial lesions and purulent rhinitis for 3 months. He also had vitiligo for 20 years. The patient had no history of smoking, alcohol consumption or systemic disease. Dermatologic examination revealed crusted and infiltrated granulomatous plaques on the anterior upper surface and side of the nose, cheeks and lower and upper lips with purulent discharge [Figure - 1]. The lesions had affected the anterior nasal septum and columella. Nasal examination showed mucopus in the nasal cavity, loss of tissue on the columella and cartilage necrosis on the anterior nasal septum and consequently, loss of tip support. In addition, depigmented macules of vitiligo were noted on the face and extremities. General physical examination was normal. Laboratory tests revealed that the white blood cell count was 20.86 × 10[3]/µL (4–10 × 10[3]/µL),

Figure 1: Massively crusted, granulomatous plaques on the central and lower face

sedimentation rate was 100 mm/h (0–12 mm/h) and C-reactive protein levels were 86.6 mg/dl (0–5 mg/dl). Other laboratory tests were within normal limits. HIV and hepatitis C tests were negative. Culture from the purulent discharge grew Pseudomonas aeruginosa. The patient was treated with levofloxacin, 750 mg by intravenous infusion for 10 days. Following treatment, suppuration decreased and granulomatous lesions became more visible. Histopathologic examination revealed acanthosis with pustule formation on the surface of follicular epithelium and a dense, diffuse inflammatory infiltrate of lymphocytes, many plasma cells and epithelioid cells in the papillary and reticular dermis [Figure - 2]a and [Figure - 2]b. These findings were suggestive of mucocutaneous leishmaniasis but no parasite was seen. Leishmania amastigotes were found in the tissue smear prepared from the edge of the lesion [Figure - 3]. On the basis of history, clinical and histopathological findings and skin smear results, mucocutaneous leishmaniasis was diagnosed. The patient was treated with systemic meglumine antimoniate, 20 mg/kg/day intramuscularly, in 2 divided doses for 30 days. The lesions improved dramatically 1 month after the treatment [Figure - 4].

Figure 2: (a and b) Acanthosis of the epidermis (e), pustule formation on the surface of the follicle, lymphocytes (l), plasma cells (pc) mixed with epithelioid histiocytes (eh) in the papillary (pd) and reticular dermis (rt) (H and E, ×40, ×100)
Figure 3: Leishmania amastigotes in the tissue smear (Giemsa stain, × 100)
Figure 4: Significant improvement 1 month after the treatment

Mucocutaneous leishmaniasis is a serious and potentially life-threatening form of the disease. It is often perceived as a New World disease almost only found in South America but rarely seen in the Old World. Mucosal manifestations can be seen in about 5–20% of cutaneous leishmaniasis. The lag period between developing cutaneous lesions and the later onset of mucosal involvement ranges from months to years. The nasal mucosa is the most commonly affected area and involvement of other mucosal sites is rare.[1] In patients with nasal mucosal involvement, the disease can begin with non-specific symptoms such as persistent nasal stuffiness, discharge, discomfort or epistaxis.[2] Our patient also presented with purulent nasal discharge.

Secondary infection is reported in 54.2% of cases and is usually caused by Staphylococcus aureus.[3] In our case, Pseudomonas aeruginosa was the cause and the patient responded well to treatment with levofloxacin.

Atypical aspects such as extensive and destructive lesions, have often been found in cases of leishmaniasis associated with HIV infection.[4] In our case, although HIV tests were negative, a massive and disfiguring central face involvement occurred in a short time.

The clinching evidence for a diagnosis of mucocutaneous leishmaniasis is the demonstration of Leishmania parasites. On biopsy, amastigotes can be seen in only 25% of the skin lesions.[5] In our case, the histopathological findings were suggestive of mucocutaneous leishmaniasis but amastigotes could not be identified. However, amastigotes were detected by direct microscopic examination.

In mucocutaneous leishmaniasis, long-term systemic treatment with pentavalent antimonials or amphotericin B is required.[5] In view of the extent and severity of the disease, our patient was treated with intramuscular meglumine antimoniate, 20 mg/kg/day for 30 days. Because of the fairly early diagnosis, appropriate treatment and the absence of any underlying primary immunodeficiency, our patient had a good prognosis. In addition, the response to treatment was dramatic.

Early diagnosis and appropriate treatment of mucocutaneous leishmaniasis is essential as there is a risk of extension of the disease and destruction of facial structures such as the nose, palate and buccal mucosa with potentially fatal pharyngeal and laryngeal involvement.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has given his consent for his images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References
1.
Osorio LE, Castillo CM, Ochoa MT. Mucosal leishmaniasis due to Leishmania (Viannia) panamensis in Colombia: Clinical characteristics. Am J Trop Med Hyg 1998;59:49-52.
[Google Scholar]
2.
Weller PF, Durand ML, Pilch BZ. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 4-2005. A 35-year-old man with nasal congestion, swelling, and pain. N Engl J Med 2005;352:609-15.
[Google Scholar]
3.
Vera LA, Macedo JL, Ciuffo IA, Santos CG, Santos JB. Antimicrobial susceptibility of aerobic bacteria isolated from leishmaniotic ulcers in Corte de Pedra, BA. Rev Soc Bras Med Trop 2006;39:47-50.
[Google Scholar]
4.
da Silva GA, Sugui D, Nunes RF, de Azevedo K, de Azevedo M, Marques A, et al. Mucocutaneous leishmaniasis/HIV coinfection presented as a diffuse desquamative rash. Case Rep Infect Dis 2014;2014:293761.
[Google Scholar]
5.
Costa JM, Saldanha AC, Nasciento D, Sampaio G, Carneiro F, Lisboa E, et al. Clınıcal modalıtıes, dıagnosıs and therapeutıc approach of the tegumentary leıshmanıasıs ın Brazıl. Bras Gaz Med Bahia 2009;79 Suppl 3:70-83.
[Google Scholar]

Fulltext Views
1,125

PDF downloads
535
Show Sections