Lesson of the month 2: Chronic erythematous painless plaque on the eyelid co-presenting with multiple ulcerated nodules on the extremities

Abstract

Cutaneous leishmaniasis is a parasitic disease caused by the Leishmania species, transmitted by the bite of an infected sandfly. The typical cutaneous lesion is a painless ulcer with a raised, indurated margin and often covered with an adherent crust. The lesions are mostly located on exposed sites such as the face and the extremities. Eyelid involvement is rare, making up only 2-5% of cases with facial cutaneous leishmaniasis. Herein, we report a 50-year-old male who presented with an erythematous plaque on the upper eyelid and multiple ulcerated nodules located on the extremities. Following microscopic examination of the lesional smear, a diagnosis of cutaneous leishmaniasis was made, and the patient was successfully treated with intramuscular meglumine antimonate therapy.

A rare cause of preseptal cellulitis: Cutaneous Leishmaniasis

“…The clinical manifestations of CL are seen in a wide spectrum depending on the Leishmania strains and the immune status of the host. The typical clinical presentation is characterized by a painless ulcer with raised edges covered with a crust adhered to a necrotic base in the affected area after an incubation period of 1–12 weeks following an infected sandfly bite ( 3 ). Fever or pain is not a feature of an ulcer ( 5 , 6 ).…”

“…The face is a common site of involvement in CL, but eyelid involvement is rare and accounts for only 2–5% of cases of facial CL ( 2 , 3 ). Durdu et al evaluated 2622 lesions of 2066 patients with CL in a prospective study conducted between 1998 and 2004 and it was found that 66 (2.5%) of the lesions were located in the periocular area in 59 (2.9%) of the patients ( 5 ).…”

“…Leishmaniasis is a disease caused by protozoan parasites of the genus Leishmania and transmitted by the bite of infected female phlebotomine sandflies ( 1 - 3 ). The disease can be seen in three forms: Cutaneous, mucocutaneous, and visceral leishmaniasis ( 3 ).…”

“…It is caused by Leishmania major and Leishmania tropica and is an important public health problem in many regions of the world ( 1 ). Cutaneous leishmaniasis is endemic in certain regions of Afghanistan, Algeria, Iran, Iraq, Saudi Arabia, Syria, Türkiye, Brazil, and Peru ( 3 ). The clinical picture is characterized by the development of single or multiple localized lesions that begin as nodules on the exposed areas of the skin bitten by sandflies typically ulcerate and usually heal spontaneously within 3–6 months ( 4 ).…”

“…Although the face is the region where the infection is the most common, the eyelids are a rare region due to the movement of the lids and eyelashes ( 2 , 4 ). Therefore, eyelid involvement accounts for 2.5% of cutaneous leishmaniasis cases ( 2 , 3 ).…”