First case of disseminated cutaneous leishmaniasis in an immunocompetent patient caused by Leishmania braziliensis in the State of Santa Catarina, Brazil

Abstract

Background: Leishmaniasis is considered a neglected tropical disease. Disseminated cutaneous leishmaniasis (DCL) is a rare form of presentation of the disease, affecting only 2% of patients. It is caused mainly by the species L. L. aethiopica, L. L. mexicana, and L. L. amazonensis. There are acneiform papules distributed throughout the body, pruritic and non-ulcerated, often associated with systemic symptoms. Methods & Materials: It is a case report accompanied in our reference service for infectious diseases. Results: We report the first case of DCL in the State of Santa Catarina, Brazil. Male patient, born in the State of Bahia, and living in Florianópolis, capital of the State of Santa Catarina. He presented an initial pruritic ulceration lesion in the left thigh, in one week new papular lesions of acneiform character appeared in the dorsum, thorax, face and scalp, there was involvement of mucosa in the glans and nasal septum. He had symptoms such as fever, asthenia, abdominal pain and associated eyelid edema. Patient sought 3 care centers due to the condition, being suspected of allergic reaction initially and subsequently of disseminated impetigo, being hospitalized and treated for it. As there was no improvement, a skin biopsy was performed for diagnostic investigation, and no pathological parasites were found in the pathology, but culture and PCR were positive for Leishmania braziliensis. Complementary investigation showed an increase in transaminases, but no other alterations. Treatment with liposomal amphotericin B was instituted. At the end of the treatment there was little improvement of the lesions, but a complete regression of the systemic symptoms. Conclusion: Santa Catarina is the third Brazilian State with the best HDI, therefore, to have as differential diagnosis a tropical disease becomes distant from the reality of medical professionals. In addition, the State has social, geographical and ecosystem characteristics that differentiate it from the other states of southern Brazil. The importance of the publication of this case is due to the low diagnostic suspicion of rare diseases in our region, thus confirming its association with local poverty. In this way, the dissemination of their presence in our environment allows other professionals to place neglected diseases in their differential diagnoses.