A CASE of a CELLULITIS-LIKE CUTANEOUS FACIAL

A CASE of a CELLULITIS-LIKE CUTANEOUS FACIAL LEISHMANIASIS
*Dr İjlal Erturan, **Dr. İbak Gönen, *Dr. Ali Murat Ceyhan, *Dr. Oya Oylum
Kazanoğlu, ***Dr. Ayşe Aynalı ****Dr. İbrahim Metin Ciriş, *Dr. Vahide Baysal
Akkaya *Suleyman Demirel University, Faculty of Medicine, Department of Dermatology
**Suleyman Demirel University, Faculty of Medicine, Department of Infectious
Diseases
***Suleyman Demirel University, Faculty of Medicine, Department of
microbiology
****Suleyman Demirel University, Faculty of Medicine, Department of Pathology
Introduction: Cutaneous leishmaniasis is a parasitic enfection that effects people in
the world-wide and its incidence is likely to increase. It is caused by a group of
protozoan parasites belonging to the genus leishmania. Old world cutaneous
leishmanisis which is primarily caused by Leishmania tropica and Leishmania major is
commonly seen in our country (1). Here we report a case of cutaneous leihmaniasis
presenting with cellulitis like lesions.
Case: A 58 year-old woman admitted to our clinic with erythematous, edematous,
indurated lesions on her face and chin. According to patient’s history, the initial lesions
appeared at the root of the nose and chin as painless acneiform papules. The papules
slowly coalesced and formed erythematous hard infiltrated plaques. The patient had
been previously diagnosed as cellulitis but did not respond to prior numerous local and
systemic antibotic therapy. She had no history of insect bite and trauma.
Dermatological examination revealed erythematous, edematous, indurated plaque
begining from her root of the nose and extending to her right eye lid, right side of the
face and also erythematous plaque on left side of the chin (Figure 1). Considering the
history, failure of response to antibiotic therapy, she was clinically suspected as a case
of cutaneous leishmaniasis. The Giemsa smear revealed amastigotes belonging to
leishmania (Figure 2). Also amastigotes were identified in histiocytes in biopsy
specimen from the lesion. According to the history, biopsy and Giemsa smear, the
patient was diagnosed as cutaneous leishmaniasis. The laboratory findings of the
patient in admition were normal. The patient hospitalized and the treatment started
initially with systemic sodium stibogluconate in a dose of 15mg/kg/day. At the 10 th
days of the treatment, liver function tests and amilase levels elevated and the count of
the white blood cells decreased. So the systemic treatment stopped. After a month of
the dischargement, the laboratory findings backed to normal and meglumine
antinmonate treatment was applied to the patient intralesionally for 20 days, with
complete resolution of the cellulitis like lesion on the face.
Discussion and conclusion: The clinical spectrum of cutaneous leishmaniasis is so
broad. It can represent a diagnostic difficulty for physicians when the disease occurs in
a nonendemic area where experience is limited. Depending on subspecies of the
Leishmania, immune response of the host and age, it may represent quite different and
atypical cutaneous manifestations which elude diagnosis in the first instance. The
occurrence of bizarre clinical presentations of the cutaneous leishmaniasis often leads
to misdiagnosis and inappropriate treatment causing significant morbidity (1,2,3). The
manifestation of cutaneous leishmaniasis with the clinical features of facial cellulitis has
been rarely documented in the published work (1,4,5,6)
This case illustrates one of the unusual forms of localized cutaneous leishmaniasis and
serves as a reminder to consider facial cutaneous leishmaniasis when presented with
prolonged facial cellulitis like eruption unresponsive to antibiotherapy. Cutaneous
leishmanyazis should be kept in mind in patients presenting with cellulitis like lesions
which do not respond to long term antibiotherapy.
References
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2Ceyhan AM, Yıldırım M, Başak PY, Akaya VB. Unusual multifocal cutaneous
leishmaniasis in a diabetic patient. Eur J Dermatol. 2009;19(5):514-5.
3Markle WH, Makhoul K. Cutaneous leishmaniasis: recognition and treatment.
Am Fam Physician 2004;69(6):1455-60.
4Ceyhan AM, Yildirim M, Basak PY, Akkaya VB, Erturan I. A case of erysipeloid
cutaneous leishmaniasis: atypical and unusual clinical variant. Am J Trop Med Hyg.
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5Karincaoglu Y, Esrefoglu M, Ozcan H. Atypical clinical form of cutaneous
leishmaniasis: erysipeloid form Int J Dermatol. 2004;43(11):827-9.
6Iftikhar N, Bari I, Ejaz A. Rare variants of Cutaneous Leishmaniasis: whitlow,
paronychia, and sporotrichoid. Int J Dermatol. 2003;42(10):807-9.
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Erturan I, Gonen I, Ceyhan AM, Kazanoglu O, Aynali A, Ciris IM, Akkaya VB.A
CASE of a CELLULITIS-LIKE CUTANEOUS FACIAL LEISHMANIASIS. The 5th
Eurasia Congress of Infectious diseases. 15-18 May 2013, Tirana, Albania