Abstract
Cutaneous leishmaniasis (CL) is the most prevalent clinical form of leishmaniasis and is caused by vector‐borne protozoan parasite. Variation in diagnostic accuracy exists. A 54‐year‐old female farmer by occupation presented with lesion over right thigh for 8 months. Lesion evolved over period of 2–3 months and progressed to form ulcer with surrounding redness. On examination, solitary plaque with crateriform ulcer 3 * 2 cm in size roughly oval in shape was present. Ulcer floor was moist, smooth shiny with serous discharge, and well‐defined raised erythematous margin was present. Biopsy was done which showed features suggestive of lupus vulgaris, for which anti‐tubercular treatment (ATT) was started. There was persistence of ulcer despite 4 months of ATT, for which diagnosis was reconsidered and fine‐needle aspiration cytology (FNAC) was performed. FNAC showed numerous intra‐ and extracellular amastigotes suggestive of leishmaniasis which was treated with complete disappearance of ulcer over 4 months.
Keywords: cutaneous leishmaniasis, fine‐needle aspiration cytology
Cutaneous leishmaniasis (CL) is the most prevalent clinical form of leishmaniasis and is caused by vector‐borne protozoan parasite. Variation in diagnostic accuracy exists. A 54‐year‐old female farmer by occupation presented with lesion over right thigh for 8 months. Lesion evolved over period of 2–3 months and progressed to form ulcer with surrounding redness. On examination, solitary plaque with crateriform ulcer 3 * 2 cm in size roughly oval in shape was present. Ulcer floor was moist, smooth shiny with serous discharge, and well‐defined raised erythematous margin was present. Biopsy was done which showed features suggestive of lupus vulgaris, for which anti‐tubercular treatment (ATT) was started. There was persistence of ulcer despite 4 months of ATT, for which diagnosis was reconsidered and fine‐needle aspiration cytology (FNAC) was performed. FNAC showed numerous intra‐ and extracellular amastigotes suggestive of leishmaniasis which was treated with complete disappearance of ulcer over 4 months.
1. BACKGROUND
Cutaneous leishmaniasis (CL) is the most prevalent clinical form of leishmaniasis and is caused by vector‐borne protozoan parasite. 1 Variation in diagnostic accuracy exists between different parasitological and histopathological examination. 2 Test of choice for diagnosis depends not only on the sensitivity and specificity of a test but also on the availability, especially in a resource‐poor setting. CL is difficult for the clinicians to diagnose because of the rarity of the disease and non‐specific presentation. Here, we report a rare case report of CL.
2. OBSERVATION
A 54‐year‐old female patient from Gorkha, farmer by occupation with frequent outdoor activities, presented with lesion over right thigh for 8 months. Initially, single pinhead sized, soft, raised lesion with brownish red color was noted over right thigh that increased in size with crust formation. Lesion evolved over period of 2–3 months and progressed to form ulcer with surrounding redness. On examination, solitary plaque with crateriform ulcer 3 * 2 cm in size roughly oval in shape was present over the right thigh, upper third aspect in the lateral part, approx. 15 cm from Anterior Superior Iliac Spine (ASIS). Ulcer floor was moist, smooth shiny with serous discharge, and well‐defined raised erythematous margin was present (Figure 1). Biopsy was done which showed features suggestive of lupus vulgaris, for which anti‐tubercular treatment (ATT) was started. There was persistence of ulcer despite 4 months of ATT, for which diagnosis was reconsidered and fine‐needle aspiration cytology (FNAC) was performed. FNAC showed numerous intra‐ and extracellular amastigotes suggestive of leishmaniasis, which was treated with complete disappearance of ulcer over 4 months.
FIGURE 1.
Solitary crateriform ulcer with erythematous halo of cutaneous leishmaniasis over right thigh, upper third aspect in the lateral part
3. DISCUSSION
As CL is rare and given the limitation of available diagnostic modalities in a resource‐poor setting, diagnosis can be confusing. Diagnosis can be made with good clinical acumen and FNAC in an endemic area. 3 With proper diagnosis, overall prevalence of the disease can be estimated and clinical therapeutic trials can be performed with timely prevention of mucocutaneous complications.
CONFLICT OF INTEREST
None.
AUTHOR CONTRIBUTIONS
Section author assisted the primary author during biopsy, and in the process of case report writing and discussion.
CONSENT
Hereby, I Dr Prajwal Pudasaini, MD consciously assure that for the manuscript CUTANEOUS LEISHMANIASIS: A CASE REPORT OF A DIAGNOSTIC DILEMMA author has confirmed during submission that patient consent has been signed and collected in accordance with the journal’s patient consent policy.
ACKNOWLEDGMENTS
I would like to express my very great appreciation to Prof Dr Saraswoti Neupane Sharma for her valuable and constructive suggestions during the planning and development of this research work. Her willingness to give her time so generously has been very much appreciated. I would also like to thank the Department of Pathology of the Gandaki Medical College and Teaching Hospital, Pokhara, for their constant support.
Pudasaini P, Pudasaini P. Cutaneous leishmaniasis: A case report of a diagnostic dilemma. Clin Case Rep. 2022;10:e05428. doi: 10.1002/ccr3.5428
Funding information
None
DATA AVAILABILITY STATEMENT
The data that support the findings of this study are openly available in clinical case reports at https://doi.org/10.22541/au.163252740.02365320/v1.
References
- 1. Hepburn NC. Cutaneous leishmaniasis: current and future management. Expert Rev Anti Infect Ther. 2003;1(4):563–570. [DOI] [PubMed] [Google Scholar]
- 2. Goto H, Lindoso JA. Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis. Expert Rev Anti Infect Ther. 2010;8(4):419–433. [DOI] [PubMed] [Google Scholar]
- 3. Hosseinzadeh M, Omidifar N, Lohrasb MH. Use of fine needle aspiration cytology in the diagnosis of cutaneous leishmaniasis: a comparison with the conventional scraping method. Trop Doct. 2012;42(2):112–113. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are openly available in clinical case reports at https://doi.org/10.22541/au.163252740.02365320/v1.