Leishmaniasis

Abstract

A 12-year-old boy presents with skin lesions on his face. He first noticed a single “red bump” below his left eyebrow 6 weeks ago while living in eastern Ecuador with his parents. The lesion has gradually become larger, extending along the length of his eyebrow, with development of a central area of ulceration. Two similar “red bumps” appeared on his face 3 days ago adjacent and inferior-lateral to the original (Fig. 51.1). The area is not painful or itchy. The boy feels well. There have been no fevers or skin rash elsewhere. His vital signs are normal. On physical examination, the primary lesion has a rubbery texture. Just off center, the top of the lesion has ulcerated. Palpation laterally and inferiorly reveals two nontender subcutaneous nodules with overlying erythema that are somewhat firmer than the primary lesion. His eye examination is normal. He has no lymphadenopathy or hepatosplenomegaly. Laboratory evaluation shows a normal complete blood count and metabolic panel. He is seronegative for human immunodeficiency virus. Several punch biopsies of the primary lesion are collected. Bacterial, fungal, and acid-fast stains and cultures are negative. Leishmania parasites are seen microscopically. Specialized cultures with biochemical testing of the pathogen and polymerase chain reaction-based diagnostic assays identify the infection pathogen as Leishmania subgenus Viannia braziliensis. Therapeutic options are presented to the family after discussion with experts from the US Center for Disease Control and Prevention. A temporary central venous catheter is inserted, and the patient is treated with a 21-day course of intravenous pentavalent antimony. Upon completion of the treatment course, the lesions have resolved completely leaving a small, residual scar. No relapses occurred subsequently.

A Clinical Practice Guideline is Available for this Topic!

https://www.idsociety.org/practice-guideline/leishmaniasis/