Development of Cutaneous Leishmaniasis after Leishmania Skin Test

Abstract

Thirty-year-old female with a previous history of a cutaneous ulcer suspicious of leishmaniasis 20 years ago presented with a new complaint of a depressed papular lesion 8 × 7 mm in the right lower extremity. The lesion was of 10-day duration. Because early cutaneous leishmaniasis (CL) lesions may have a non-ulcerated appearance, a Leishmania skin test (LST) was performed on the forearm with a strong positive result (38 × 32 mm). After 8 days, the lesion in the leg, which was diagnosed as folliculitis, completely healed. However, a typical CL ulcer (26 × 24 mm) developed at the LST site. Histopathology of the new lesion did not identifiy parasites, but the findings were consistent with a diagnosis of CL. Further analysis identified amastigotes by immunohistochemical stain. Mononuclear cells harvested from the patient were stimulated with Leishmania antigen and showed high levels of production of both tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ): 2,943 pg/mL and 2,313 pg/mL, respectively. After 40 days of treatment with antimony and pentoxifylline, the ulcer resolved. The development of CL at the LST site suggests a strong Th1 immune response, and it is an in vivo documentation of the role of the host immune response in the pathology of CL. It teaches us that LST should be cautiously, if at all, used in patients with self-healing CL ulcers.

Erythema Exsudativum Multiforme after a Leishmania Skin Test

“…This case supports the hypothesis that an exacerbated host immune response against Leishmania antigens may be associated with tissue damage and several clinical manifestations including EEM2,3; this case should alert the clinicians that Leishmania skin test is not totally risk free and may trigger hypersensitivity reactions.…”

A prospective cohort study of Cutaneous Leishmaniasis due to Leishmania major: Dynamics of the Leishmanin skin test and its predictive value for protection against infection and disease

“…In humans, the outcome of infection by Leishmania parasites is a result of a complex interplay between the host immune system and the inoculated parasites [12,[43][44][45][46]. Although many aspects of vector-pathogen interactions have been successfully deciphered, important questions related to mechanisms of resistance or susceptibility to Leishmania in humans, are still poorly understood.…”

Utilização do alvo hsp70 em técnicas de biologia molecular para diferenciação de subgêneros de Leishmania spp

“…O parasito já foi descrito em todas as formas clínicas cutânea da doença, sendo que é a única causadora da leishmaniose cutânea difusa no Brasil. (Grimaldi et al , 1989;Brandao Filho et al, 2011 (Grimaldi et al, 1989;Brandao Filho et al, 2011;Guerra et al , 2011 guyanensis (Chrusciak-Talhari et al , 2011;Machado et al , 2011).…”