Cutaneous Leishmaniasis: An Overlooked Etiology of Midfacial Destructive Lesions

• Published in: PLoS neglected tropical diseases 2016-02, Vol.10 (2), p.e0004426-e0004426
• Main Authors: Alam, Elie, Abbas, Ossama, Moukarbel, Roger, Khalifeh, Ibrahim
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age; Biology and Life Sciences; Biopsy; Child; Child, Preschool; Cutaneous leishmaniasis; Development and progression; Diagnosis; Epidemics; Etiology (Medicine); Female; Females; Funding; Humans; Infant; Leishmania; Leishmaniasis, Cutaneous - complications; Male; Medicine and Health Sciences; Meglumine - administration & dosage; Meglumine Antimoniate; Middle Aged; Mortality; Nose - abnormalities; Nose Diseases - drug therapy; Nose Diseases - etiology; Organometallic Compounds - administration & dosage; Parasitic diseases; Patients; Pediatrics; Polymerase Chain Reaction; Research and Analysis Methods; Risk factors; Tropical diseases; Young Adult
• ISSN: 1935-2735; 1935-2727; 1935-2735
• DOI: 10.1371/journal.pntd.0004426

Midline destructive lesions of the face (MDL) have a wide range of etiologies. Cutaneous Leishmaniasis (CL) is rarely reported as a possible cause. Fifteen patients with solitary nasal lesions caused by CL were studied. The clinical data, biopsies/scrapings and PCR were collected/performed. Ridley's Pattern (RP) and Parasitic Index (PI) were documented. Patients' age ranged from 1 to 60 years including 7 males and 8 females. The duration of the observed lesions ranged from 1 to 18 months. Clinically, the lesions showed 6 patterns varying from dermal erythematous papulonodular with no epidermal changes to destructive erythematous plaque with massive central hemorrhagic crust. The clinical impression ranged from neoplastic to inflammatory processes. RP varied among the cases [RP 3 (n = 6), RP 4 (n = 3), RP 5 (n = 6)]. All cases show low PI [PI 0 (n = 7), PI 1 (n = 6), PI 2 (n = 1), and PI 3 (n = 1)]. Higher PI was noted in the pediatric group [average age 24 years for PI 0-1 vs. 6.5 years for PI 2-3]. Molecular speciation showed Leishmania tropica (n = 13) and Leishmania major (n = 2). All the patients received Meglumine Antimoniate (Glucantine) injections and had initial cure defined as complete scarring and disappearance of inflammatory signs within 3 months. Leishmaniasis may cause MDL especially in endemic areas. PCR is instrumental in confirming the diagnosis. MDL caused by CL showed wide spectrum of clinical and microscopic presentation.