Diffuse Cutaneous Leishmaniasis With Atypical Aspects

Abstract

A 16-year-old man had long-standing diffuse cutaneous leishmaniasis with the following characteristics: diffuse infiltrated lesions rich in amastigotes, absence of mucosal involvement, and lack of parasite-specific cell-mediated immune response. In situ identification of Leishmania mexicana amazonensis was achieved by the use of monoclonal antibodies. Clinically, as an atypical finding there was deep and extensive ulceration in the lower limbs. Histologically, an atypical characteristic was the presence of a high number of eosinophils in the infiltrate predominantly in the ulcerated lesion. Ultrastructurally, parasitized and lysed eosinophils with dispersion of their granules were seen in the vicinity of parasitized or lysed macrophages.

Uso de anfotericina B liposomal en leishmaniasis cutánea diseminada causada por Leishmania braziliensis en un paciente pediátrico con síndrome de Down

“…En el caso de la LD, es causada principalmente por Leishmania (Viannia) braziliensis, sin embargo, también existen reportes de otras especies del subgénero Viannia. Por el contrario, la LCD es causada principalmente por el subgénero Leishmania (12,13) , aunque hay registros inusuales causados por otras especies (14) .…”

Skin Infections

“…750 Microscopic examination of mucosal lesions usually reveals extensive ulceration flanked by pseudoepitheliomatous hyperplasia. 741,742 Mucocutaneous Leishmaniasis Mucocutaneous leishmaniasis is seen mainly in South and Central America (caused by L. braziliensis, L. panamensis, and L. guyanensis) 743 but has also been reported in patients with L. infantum, 744 L. tropica, 745 and L. major 746 granulomas are often seen. 751 Tuberculoid and suppurative lymphocytes, and an occasional giant cell; parasites are hard to find.…”

Eosinophils of patients with localized and diffuse cutaneous leishmaniasis: Differential response to Leishmania mexicana, with insights into mechanisms of damage inflicted upon the parasites by eosinophils

“…Furthermore, a close association between eosinophils and parasitized macrophages has been reported in chronic lesions, suggesting that eosinophils may contribute to parasite destruction through cooperation with macrophages [ 6 ]. Tissue eosinophilia has been observed in DCL patients, with evidence of parasitized and lysed eosinophils and dispersion of their granules near parasitized macrophages [ 7 ]. Additionally, both in the mouse model of leishmaniasis and in humans with chronic phases of the disease, eosinophils are frequently found in granulomas [ 8 – 10 ].…”