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Leishmaniasis recidiva cutis of the lips mimicking granulomatous cheilitis.

Ekiz Ö, Rifaioǧlu EN, Şen BB, Çulha G, Özgür T, Doǧramaci AÇ - Indian J Dermatol (2015 Mar-Apr)

Bottom Line: The patient was treated with meglumine antimoniate intramuscularly and fluconazole orally.Cryotherapy was applied to the residual papular lesions.The lesion improved markedly at the first month of the treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Mustafa Kemal University School of Medicine, Hatay, Turkey.

ABSTRACT
Leishmaniasis recidiva cutis (LRC) is an unusual form of acute cutaneous leishmaniasis. Herein, we present a case of LRC of the lips mimicking granulomatous cheilitis. An 8-year-old, Syrian child admitted with a swelling and disfigurement of his lips for 4 years. Abundant intra and extracellular Leishmania amastigotes were determined in the smear prepared from the lesion with Giemsa stain. Histopathology showed foamy histiocytes and leishmania parasites within the cytoplasm of macrophages in the epidermis and a dense dermal mixed type inflammatory cell infiltrate composed of lymphocytes, foamy histiocytes with multinucleated giant cells. On the basis of anamnestic data, the skin smears results, clinical and histopathologic findings, LRC was diagnosed. The patient was treated with meglumine antimoniate intramuscularly and fluconazole orally. Cryotherapy was applied to the residual papular lesions. The lesion improved markedly at the first month of the treatment.

No MeSH data available.


Related in: MedlinePlus

Clinical pictures of the patient before treatment (a and b) and after 1 month of the treatment (c and d)
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Figure 1: Clinical pictures of the patient before treatment (a and b) and after 1 month of the treatment (c and d)

Mentions: An 8-year-old, healthy, Syrian boy was admitted to our outpatient clinic of dermatology with a swelling and disfigurement of his lips existing for the last 4 years. The initial lesion had started as asymptomatic papules, 0.5-1 cm in diameter on cheek and lip when he was two years old. After the treatment with intralesional meglumine antimoniate (Glucantime(R)) in Syria at that time, the lesions disappeared; however, cribriform scarring on the lip and cheek remained. Two years later, new lesions began as papules, 1 cm in diameter around the cribriform scars on the lips and cheeks. Dermatologic examination showed the presence of a severe swelling and purulent draining, crusty infiltrated granulomatous plaques on the lower and upper lips. A 5 cm cribriform scarring and 1 cm papule on this scar were seen on the left cheek [Figures 1a and b]. General physical examination did not show any pathological findings. Regional lymph nodes were not involved. Laboratory tests revealed Hb 10.3 g/dl (12.2-18.1 g/dl), Hct 30.5% (37.7-53.7%), sedimentation rate 70 mm/h (0-12 mm/h), C reactive protein 42.4 mg/dl (0-5 mg/dl). Abundant intra and extracellular Leishmania amastigotes were determined in the smear prepared from the lesion with Giemsa stain [Figure 2]. Histopathology showed foamy histiocytes and leishmania parasites within the cytoplasm of macrophages in the epidermis and a dense dermal mixed type inflammatory cell infiltrate composed of lymphocytes and foamy histiocytes with multinucleated giant cells [Figure 3]. On the basis of these findings, LRC was diagnosed. The patient was treated with 20 mg/kg/day systemic meglumine antimoniate intramuscularly, for 20 days. Because the healing was slow, he was also prescribed oral fluconazole 5 mg/kg/day for 4 weeks. Cryotherapy was applied to the residual papular lesions. The lesion improved markedly at the first month of the treatment [Figures 1c and d].


Leishmaniasis recidiva cutis of the lips mimicking granulomatous cheilitis.

Ekiz Ö, Rifaioǧlu EN, Şen BB, Çulha G, Özgür T, Doǧramaci AÇ - Indian J Dermatol (2015 Mar-Apr)

Clinical pictures of the patient before treatment (a and b) and after 1 month of the treatment (c and d)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4372960&req=5

Figure 1: Clinical pictures of the patient before treatment (a and b) and after 1 month of the treatment (c and d)
Mentions: An 8-year-old, healthy, Syrian boy was admitted to our outpatient clinic of dermatology with a swelling and disfigurement of his lips existing for the last 4 years. The initial lesion had started as asymptomatic papules, 0.5-1 cm in diameter on cheek and lip when he was two years old. After the treatment with intralesional meglumine antimoniate (Glucantime(R)) in Syria at that time, the lesions disappeared; however, cribriform scarring on the lip and cheek remained. Two years later, new lesions began as papules, 1 cm in diameter around the cribriform scars on the lips and cheeks. Dermatologic examination showed the presence of a severe swelling and purulent draining, crusty infiltrated granulomatous plaques on the lower and upper lips. A 5 cm cribriform scarring and 1 cm papule on this scar were seen on the left cheek [Figures 1a and b]. General physical examination did not show any pathological findings. Regional lymph nodes were not involved. Laboratory tests revealed Hb 10.3 g/dl (12.2-18.1 g/dl), Hct 30.5% (37.7-53.7%), sedimentation rate 70 mm/h (0-12 mm/h), C reactive protein 42.4 mg/dl (0-5 mg/dl). Abundant intra and extracellular Leishmania amastigotes were determined in the smear prepared from the lesion with Giemsa stain [Figure 2]. Histopathology showed foamy histiocytes and leishmania parasites within the cytoplasm of macrophages in the epidermis and a dense dermal mixed type inflammatory cell infiltrate composed of lymphocytes and foamy histiocytes with multinucleated giant cells [Figure 3]. On the basis of these findings, LRC was diagnosed. The patient was treated with 20 mg/kg/day systemic meglumine antimoniate intramuscularly, for 20 days. Because the healing was slow, he was also prescribed oral fluconazole 5 mg/kg/day for 4 weeks. Cryotherapy was applied to the residual papular lesions. The lesion improved markedly at the first month of the treatment [Figures 1c and d].

Bottom Line: The patient was treated with meglumine antimoniate intramuscularly and fluconazole orally.Cryotherapy was applied to the residual papular lesions.The lesion improved markedly at the first month of the treatment.

View Article: PubMed Central - PubMed

Affiliation: Department of Dermatology, Mustafa Kemal University School of Medicine, Hatay, Turkey.

ABSTRACT
Leishmaniasis recidiva cutis (LRC) is an unusual form of acute cutaneous leishmaniasis. Herein, we present a case of LRC of the lips mimicking granulomatous cheilitis. An 8-year-old, Syrian child admitted with a swelling and disfigurement of his lips for 4 years. Abundant intra and extracellular Leishmania amastigotes were determined in the smear prepared from the lesion with Giemsa stain. Histopathology showed foamy histiocytes and leishmania parasites within the cytoplasm of macrophages in the epidermis and a dense dermal mixed type inflammatory cell infiltrate composed of lymphocytes, foamy histiocytes with multinucleated giant cells. On the basis of anamnestic data, the skin smears results, clinical and histopathologic findings, LRC was diagnosed. The patient was treated with meglumine antimoniate intramuscularly and fluconazole orally. Cryotherapy was applied to the residual papular lesions. The lesion improved markedly at the first month of the treatment.

No MeSH data available.


Related in: MedlinePlus