Leishmaniasis (old World cutaneous)

Diagnosis: Leishmaniasis (old World cutaneous)

Erythematous and crusted plaque on nose.

Clinical Presentation

Erythematous and crusted plaque on nose.

Clinical History

Submitted by Alaa Saad. Originally posted November 14, 2010.

Treatment

See case discussion.

Differential Diagnosis

• Squamous cell carcinoma • Basal cell carcinoma • Lupus vulgaris (cutaneous TB) • Sporotrichosis • Foreign body granuloma • Sarcoidosis • Keratoacanthoma

Key Learnings

• Caused by Leishmania parasites transmitted by phlebotomine sandfly bite • Three main forms: cutaneous (most common), mucocutaneous, visceral (kala-azar) • Cutaneous: painless papule → nodule → ulcer with raised borders at bite site • Old World CL (L. major, L. tropica): tends to self-heal in 6-12 months • New World CL (L. braziliensis): risk of mucocutaneous disease — nasal/oral destruction • Amastigotes (Leishman-Donovan bodies) seen within macrophages on Giemsa stain • Diagnosis: touch prep/smear, PCR, culture (NNN medium), skin biopsy

Tags: leishmaniasis, old, world, cutaneous, alaa saad