Abstract
BackgroundMidline destructive lesions of the face (MDL) have a wide range of etiologies. Cutaneous Leishmaniasis (CL) is rarely reported as a possible cause.MethodsFifteen patients with solitary nasal lesions caused by CL were studied. The clinical data, biopsies/scrapings and PCR were collected/performed. Ridley’s Pattern (RP) and Parasitic Index (PI) were documented.ResultsPatients’ age ranged from 1 to 60 years including 7 males and 8 females. The duration of the observed lesions ranged from 1 to 18 months. Clinically, the lesions showed 6 patterns varying from dermal erythematous papulonodular with no epidermal changes to destructive erythematous plaque with massive central hemorrhagic crust. The clinical impression ranged from neoplastic to inflammatory processes. RP varied among the cases [RP 3 (n = 6), RP 4 (n = 3), RP 5 (n = 6)]. All cases show low PI [PI 0 (n = 7), PI 1 (n = 6), PI 2 (n = 1), and PI 3 (n = 1)]. Higher PI was noted in the pediatric group [average age 24 years for PI 0–1 vs. 6.5 years for PI 2–3]. Molecular speciation showed Leishmania tropica (n = 13) and Leishmania major (n = 2). All the patients received Meglumine Antimoniate (Glucantine) injections and had initial cure defined as complete scarring and disappearance of inflammatory signs within 3 months.ConclusionLeishmaniasis may cause MDL especially in endemic areas. PCR is instrumental in confirming the diagnosis. MDL caused by CL showed wide spectrum of clinical and microscopic presentation.
Highlights
Midline destructive lesions of the face (MDL) were reported initially in 1897 and over time there have been many terms used to describe them [1]
The lesions showed 6 patterns varying from dermal erythematous papulonodular with no epidermal changes to destructive erythematous plaque with massive central hemorrhagic crust
Higher Parasitic Index (PI) was noted in the pediatric group [average age 24 years for PI 0–1 vs. 6.5 years for PI 2–3]
Summary
Midline destructive lesions of the face (MDL) were reported initially in 1897 and over time there have been many terms used to describe them [1]. The most common ones include idiopathic midline destructive disease, lethal midline granuloma, and idiopathic midline granuloma [2]. The various terms used all shared a common descriptive goal which is an ulcerative process leading to cartilage and epithelium loss along with crusting that leads to loss of nasal structure along with a resultant functional and cosmetic deformity. The differential diagnosis of such lesions is wide and falls in mainly five categories; neoplastic, autoimmune, traumatic, infectious or idiopathic. Despite advancements in the medical field, diagnosis of such lesions is often incorrect or missed. Midline destructive lesions of the face (MDL) have a wide range of etiologies. Editor: Carlos Franco-Paredes, Hospital Infantil de Mexico Federico Gomez, UNITED STATES
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