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©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
Cutaneous leishmaniasis in Louisiana - one-year follow-up: A case report
Ashaur Azhar, Hillary E Connell, Christopher Haas, Jelena Surla, Devin Reed, Sanjay Kamboj, Gordon L Love, Yussef Bennani
Ashaur Azhar, Yussef Bennani, 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, Jelena Surla, Devin Reed, Sanjay Kamboj, 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
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
Author contributions: Azhar A contributed in designing, drafting, revising, approving, correspondence and submission of the manuscript; Connell HE worked extensively in literature review process; Bennani Y contributed in the final revision and approval of manuscript; Love GL contributed in the interpretation of the histopathology slides. All authors were involved in the care of this patient in the hospital.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The corresponding author declares that he has no conflict of interest related to this case report.
CARE Checklist (2016) statement: The corresponding author has read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016) for a case report.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ashaur Azhar, MD, Assistant Professor, Department of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center, School of Medicine, 1542 Tulane Avenue, Suite 331C, New Orleans, LA 70112, United States.
aazha1@lsuhsc.edu
Received: August 13, 2020
Peer-review started: August 7, 2020
First decision: September 21, 2020
Revised: October 19, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: January 15, 2021
Processing time: 152 Days and 18.7 Hours
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.
Core Tip: This case highlights the importance of prompt and accurate diagnosis, and appropriate treatment of cutaneous leishmaniasis to prevent further complications and advancement to mucosal form. It should be considered in the differential diagnosis of skin lesions with appropriate epidemiologic context. Oral therapy with miltefosine is available for use as in this case. It is important to evaluate for human immune-deficiency virus disease since presentation and complications in immunosuppressed individuals can be more severe.
