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. 1996 Jun;49(6):517–519. doi: 10.1136/jcp.49.6.517

Caseous necrosis in cutaneous leishmaniasis.

E Peltier 1, P Wolkenstein 1, M Deniau 1, E S Zafrani 1, J Wechsler 1
PMCID: PMC500549  PMID: 8763273

Abstract

A case of late stage cutaneous leishmaniasis with focal caseous necrosis is reported. The patient, a 30 year old Tunisian man, presented with idiopathic bone marrow aplasia. Microscopically, minimal changes were observed in the epidermis: slight hyperkeratosis and moderate acanthosis. Lesions predominated in the dermis. Epithelioid granulomas were found in the lower dermis. Some of these lesions were clearly surrounded by a ring of lymphocytes and were rarely confluent. A peculiar histological feature was the presence of focal acidophilic and slightly granular necrosis at the centre of some the tuberculoid lesions. Focal fibrinoid necrosis was found in the upper dermis, outside granulomas. A mild to moderate infiltrate of histiocytes, lymphocytes and plasma cells, with scanty neutrophils, was observed mainly in the upper dermis. No intracellular or extracellular Leishman-Donovan bodies were observed. Acid fast mycobacteria, however, were not detected. Leishmaniasis was diagnosed on culture of skin biopsy specimens. The presence of caseous necrosis could lead to diagnostic confusion and result in an erroneous diagnosis of, for example, tuberculosis, syphilis, acne agminata, and sarcoidosis with fibrinoid necrosis. This is especially the case when parasites are scanty or absent.

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Selected References

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  1. Al-Gindan Y., Abdul-Aziz O., Kubba R. Cutaneous leishmaniasis in Al-Hassa, Saudi Arabia. Int J Dermatol. 1984 Apr;23(3):194–197. doi: 10.1111/j.1365-4362.1984.tb04510.x. [DOI] [PubMed] [Google Scholar]
  2. BIAGI F. Sintesis de 70 historias clinicas de leishmaniasis tegumentaria de Mexico (úlcera de los chicleros). Medicina (Mex) 1953 Aug 25;33(682):385–396. [PubMed] [Google Scholar]
  3. CONVIT J., KERDEL-VEGAS F. DISSEMINATED CUTANEOUS LEISHMANIASIS; INNOCULATION TO LABORATORY ANIMALS, ELECTRON MICROSCOPY AND FLUORESCENT ANTIBODIES STUDIES. Arch Dermatol. 1965 May;91:439–447. doi: 10.1001/archderm.1965.01600110025007. [DOI] [PubMed] [Google Scholar]
  4. Essa M. H., Mangoud A. M., Morsy T. A., Aly M. A., Salama M. M. Vascular changes in cutaneous leishmaniasis. J Egypt Soc Parasitol. 1989 Dec;19(2):683–687. [PubMed] [Google Scholar]
  5. Esterre P., Dedet J. P., Frenay C., Chevallier M., Grimaud J. A. Cell populations in the lesion of human cutaneous leishmaniasis: a light microscopical, immunohistochemical and ultrastructural study. Virchows Arch A Pathol Anat Histopathol. 1992;421(3):239–247. doi: 10.1007/BF01611181. [DOI] [PubMed] [Google Scholar]
  6. Farah F. S., Malak J. A. Cutaneous leishmaniasis. Arch Dermatol. 1971 May;103(5):467–474. [PubMed] [Google Scholar]
  7. Kurban A. K., Malak J. A., Farah F. S., Chaglassian H. T. Histopathology of cutaneous leishmaniasis. Arch Dermatol. 1966 Apr;93(4):396–401. [PubMed] [Google Scholar]
  8. Locksley R. M., Heinzel F. P., Sadick M. D., Holaday B. J., Gardner K. D., Jr Murine cutaneous leishmaniasis: susceptibility correlates with differential expansion of helper T-cell subsets. Ann Inst Pasteur Immunol. 1987 Sep-Oct;138(5):744–749. doi: 10.1016/s0769-2625(87)80030-2. [DOI] [PubMed] [Google Scholar]
  9. Paksoy N., Hekim E. Comparative analysis of the clinicopathological features in cutaneous leishmaniasis and lupus vulgaris in Turkey. Trop Med Parasitol. 1993 Mar;44(1):37–39. [PubMed] [Google Scholar]
  10. Pirmez C., Cooper C., Paes-Oliveira M., Schubach A., Torigian V. K., Modlin R. L. Immunologic responsiveness in American cutaneous leishmaniasis lesions. J Immunol. 1990 Nov 1;145(9):3100–3104. [PubMed] [Google Scholar]
  11. Ridley D. S., Ridley M. J. Late-stage cutaneous leishmaniasis: immunopathology of tuberculoid lesions in skin and lymph nodes. Br J Exp Pathol. 1984 Jun;65(3):337–346. [PMC free article] [PubMed] [Google Scholar]
  12. Ridley D. S. The pathogenesis of cutaneous leishmaniasis. Trans R Soc Trop Med Hyg. 1979;73(2):150–160. doi: 10.1016/0035-9203(79)90199-8. [DOI] [PubMed] [Google Scholar]
  13. Ridley M. J., Ridley D. S. Cutaneous leishmaniasis: immune complex formation and necrosis in the acute phase. Br J Exp Pathol. 1984 Jun;65(3):327–336. [PMC free article] [PubMed] [Google Scholar]
  14. Rioux J. A., Lanotte G., Serres E., Pratlong F., Bastien P., Perieres J. Taxonomy of Leishmania. Use of isoenzymes. Suggestions for a new classification. Ann Parasitol Hum Comp. 1990;65(3):111–125. doi: 10.1051/parasite/1990653111. [DOI] [PubMed] [Google Scholar]
  15. Sangueza O. P., Sangueza J. M., Stiller M. J., Sangueza P. Mucocutaneous leishmaniasis: a clinicopathologic classification. J Am Acad Dermatol. 1993 Jun;28(6):927–932. doi: 10.1016/0190-9622(93)70132-d. [DOI] [PubMed] [Google Scholar]
  16. Stratigos J. D. New aspects on cutaneous leishmaniasis. Derm Beruf Umwelt. 1980;28(5):139–148. [PubMed] [Google Scholar]
  17. Strick R. A., Borok M., Gasiorowski H. C. Recurrent cutaneous leishmaniasis. J Am Acad Dermatol. 1983 Sep;9(3):437–443. doi: 10.1016/s0190-9622(83)70156-8. [DOI] [PubMed] [Google Scholar]

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