Abstract
Cutaneous leishmaniasis may mimic other infections in overlapping endemic areas and timely treatment prevents dissemination of the parasite. The required histopathological and microbiological examinations are not always available, and can only give a deferred confirmation of the diagnosis. In contrast, reflectance confocal microscopy (RCM) allows real-time visualization till the level of papillary dermis. A 59-year-old Brazilian male presented with ulcerated plaques and tumors on the extremities. The clinical differential diagnosis included leishmaniasis and other infections with lymphocutaneous pattern of dissemination. RCM showed the characteristic picture of «eggs in a bird’s nest» which has been described in cutaneous leishmaniasis. The diagnosis of leishmaniasis was later confirmed by skin biopsy, in which Leishmania guyanensis was identified by parasitological examination. After treatment with liposomal amphotericin B, reassessment with RCM corroborated the clinical cure, showing an «empty nest» picture. In conclusion, RCM noninvasively provides useful information for diagnosis and follow-up of cutaneous leishmaniasis.
Highlights
Cutaneous leishmaniasis is distributed worldwide and can mimic other cutaneous infections in the same endemic areas.[1]
Unlike visceral leishmaniasis, which is concentrated in particular regions of Asia, Sudan and Brazil, cutaneous leishmaniasis is evenly distributed in Western Asia, the Mediterranean region, and Latin America.[2]
Leishmaniasis is endemic to more than 90 countries worldwide and world travel has brought the parasite to nonendemic regions.[1]
Summary
Leishmaníase do Novo Mundo: O Papel da Microscopia Confocal no Diagnóstico e Seguimento Dermatologia Tropical. O diagnóstico de leishmaníase foi confirmado em biópsia cutânea, identificando-se a espécie Leishmania guyanensis no exame parasitológico. A MCR, de forma não invasiva, apoia o diagnóstico e seguimento da leishmaníase cutânea. PALAVRAS-CHAVE – Dermoscopia; Leishmania; Leishmaníase Cutânea/diagnóstico; Microscopia Confocal. New World Leishmaniasis: The Role of Confocal Microscopy in Diagnosis and Follow-up - Tropical Dermatology. RCM showed the characteristic picture of «eggs in a bird’s nest» which has been described in cutaneous leishmaniasis. The diagnosis of leishmaniasis was later confirmed by skin biopsy, in which Leishmania guyanensis was identified by parasitological examination. RCM noninvasively provides useful information for diagnosis and follow-up of cutaneous leishmaniasis. KEYWORDS – Dermoscopy; Leishmania; Leishmaniasis, Cutaneous/diagnosis; Microscopy, Confocal
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