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Azhar A, Connell HE, Haas C, Surla J, Reed D, Kamboj S, Love GL, Bennani Y. Cutaneous leishmaniasis in Louisiana - one-year follow-up: A case report. World J Clin Infect Dis 2021; 11:19-26. [DOI: 10.5495/wjcid.v11.i1.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/19/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Reports of leishmaniasis are scarce in North America. It is considered to be one of the neglected tropical diseases. It is seen in immigrants from endemic areas to United States. Treatments are not readily available in the United States. Untreated or inadequately treated cutaneous leishmaniasis not only causes localized disfigurement but can advance to more permanent and devastating mucosal disfigurement and perforation, if caused by a species that can also cause mucocutaneous leishmaniasis.
CASE SUMMARY A 42-year-old human immunodeficiency virus negative male immigrant from Honduras presented to the emergency department of our facility in Louisiana with a 2-mo history of a left lower extremity ulcer. It started as a painless blister that progressed in size and developed into other smaller lesions tracking up the thigh and became tender and erythematous. Clinically looked nontoxic and healthy. He was afebrile. Blood tests, except inflammatory markers, were within normal limits. The cellulitis of the leg was treated with 6 d of vancomycin that also relieved the pain. Skin biopsy was obtained, and histopathology was suspicious for leishmania. Polymerase chain reaction/deoxyribonucleic acid sequencing done by centers for disease control and prevention confirmed the diagnosis as Leishmania panamensis. There was no involvement of naso-oropharyngeal mucosa, confirmed by otolaryngology. The patient was treated with miltefosine for 28 d. Clinic follow-up after approximately 11 mo revealed a healed skin ulcer.
CONCLUSION Cutaneous leishmaniasis should be in the differential diagnosis of skin ulcers of travelers from endemic areas. Awareness regarding diagnosis and treatment of leishmaniasis needs to be enhanced.
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Affiliation(s)
- Ashaur Azhar
- Department of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA 70112, United States
| | - Hillary E Connell
- Department of Medicine, Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA 70112, United States
| | - Christopher Haas
- Department of Dermatology, Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA 70112, United States
| | - Jelena Surla
- Department of Medicine, Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA 70112, United States
| | - Devin Reed
- Department of Medicine, Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA 70112, United States
| | - Sanjay Kamboj
- Department of Medicine, Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA 70112, United States
| | - Gordon L Love
- Jack Perry Strong Professor and Chair, Department of Pathology, Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA 70112, United States
| | - Yussef Bennani
- Department of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center, School of Medicine, New Orleans, LA 70112, United States
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