We report an autochthonous case of simple, localized cutaneous leishmaniasis in a healthy 18-month-old girl from southern Thailand. The patient presented with a solitary chronic cutaneous nodular lesion on her left cheek for approximately 1 year. Histopathological dissection of the cheek skin biopsy demonstrated remarkably nodular and interstitial infiltrates of lymphocytes and histiocytes full of intracellular oval-shaped amastigotes, consistent with cutaneous leishmaniasis. The Leishmania promastigotes were also cultured successfully from the lesion biopsy and were designated with the WHO code MHOM/TH/2021/CULE5. Using internal transcribed spacer 1-specific polymerase chain reaction, the parasite DNA was demonstrated in both saliva and lesion biopsy. Based on the BLASTn and phylogenetic analysis, the parasite was identified as Leishmania orientalis, clustered in the Mundinia subgenus. The patient responded well to a 6-week course of oral itraconazole, without recurrence. To our knowledge, this is the fourth case of autochthonous leishmaniasis resulting from L. orientalis and the youngest patient of leishmaniasis ever reported in Thailand. More importantly, we also demonstrate the clinical course of the lesion according to the timeline before and after treatment, which can help physicians better understand and provide an accurate diagnosis with appropriate treatment of this emerging parasitic disease.
Nowadays, organ transplantation is a potentially curative treatment for many congenital and acquired diseases in both adult and pediatric patients. Over the past decades, immunosuppressive regimens, surgical techniques, and transplant units have brought excellent and efficacious outcomes. Several organs could be transplanted, such as solid organs like liver and kidney, especially by both liver transplantation and HSCT.LT is the standard of care for children with acute or chronic liver diseases, including acute liver failure, end-stage liver diseases such as biliary atresia, certain metabolic disorders, and unresectable hepatic tumors. 1 Advances in surgical techniques and immunosuppression have led to excellent short-and long-term patient survivals. 2 In particular, the life-long immunosuppression is crucial to prevent graft rejection. Therefore, the recipients are at risk of having long-term complications from immunosuppression, such as infection, renal dysfunction, metabolic diseases (diabetes mellitus, hypertension, dyslipidemia), and tumors. [1][2][3] Dermatologic complications are one of the sequelae after transplantation. The long-term outcome findings range from benign, non-life-threatening conditions (such as local bacterial or fungal infections) to malignant complications (eg, post-transplant lymphoproliferative disease and skin cancer). 3,4
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