Disseminated Cutaneous Leishmaniasis in Colombia: Report of 27 Cases

Abstract

Disseminated leishmaniasis (DL) is a poorly described disease that is frequently misdiagnosed as other clinical manifestations of cutaneous leishmaniasis (CL) such as diffuse CL or post-kala-azar dermal leishmaniasis. Twenty-seven cases of DL diagnosed between 1997 and 2015 are described. A higher prevalence was observed in men (mean age 32 years). The number of lesions per patient ranged from 12 to 294, distributed mainly in the upper extremities, face and trunk. The lesions were mostly plaques or nodules. Seven patients had nasal mucous damage, 74% of the patients were of mixed race, 92% lived in northwestern Colombia, and Leishmania (Viannia) panamensis was identified as the causative agent in 58% of cases. Eighteen patients recovered with pentavalent antimonial. The importance of distinguishing DL from those other clinical presentations is based on the fact that disseminated, diffuse and post-kala-azar CL are very different in etiology, clinical manifestations and response to treatment and prognosis.

Clinicopathological presentation of cutaneous leishmaniasis and its diagnostic algorithm

“…The study concluded the good treatment response, prognosis for disseminated leishmaniasis and thereby emphasized the significance of prompt diagnosis of disseminated leishmaniasis. These findings contradicted the observations of earlier study from Brazil in 2013 [16].…”

“…These findings correlated with occurrence of (18.2%) caseating granulomas [15]. Velez et al has reported a series of 27 cases of disseminated leishmaniasis from Colombia in 2015 [16]. They observed that it has distinct clinical presentation of presence of high number of skin lesions (greater than 10 polymorphic lesions) in at least two parts of body surface with or without mucosal involvement.…”

Leishmaniasis cutánea en la provincia del Magdalena Centro, Cundinamarca, Colombia. Una serie de casos

“…Entre los estudios descriptivos se encuentra el realizado por Vélez y colaboradores [5], en Antioquia, el cual informa 27 casos, pero en un periodo de 18 años.…”

“…La presentación más frecuente en Colombia es la úlcera indolora con afectación linfangítica y adenopatía regional [5].…”

First case report of atypical disseminated cutaneous leishmaniasis in an opium abuser in Iran

“…DCL has been described in many countries, with a significant increase in the number of severe cases in highly endemic areas in the New World, and more recently in the Old World. It is characterized by an initial injury of the superficial and then the deep dermis followed by a high number of cutaneous polymorphic lesions with distinct features in the patient’s body surface, with or without mucosal involvement and usually having no effective response to treatment 14 , 15 .…”