Skin Features Accompanying Imported Human African Trypanosomiasis: HemolymphaticTrypanosoma gambienseInfection Among Two French Expatriates With Dermatologic Manifestations

Abstract

Dermatologic conditions are commonly encountered among returned travellers and long‐term residents of the tropics.1 Indeed, many serious infections acquired during travel or stay in tropical countries are associated with skin manifestations that may provide important diagnostic and care clues. The location of lesions, their pattern, and the presence of associated symptoms such as pruritus or fever are important to consider in establishing a prompt and appropriate diagnosis. This critical circumstance is illustrated by the following case reports that describe two French expatriates with human African trypanosomiasis due to Trypanosoma brucei gambiense who had been diagnosed with delay, at the hemolymphatic stage of the disease and within a presentation comprising characteristic although sparsely reported cutaneous involvement. ### Patient 1 A 37‐year‐old French expatriate worker was evacuated from Libreville, Gabon, to be admitted in our clinic because of a febrile illness with fatigue, anorexia, and arthralgias. The patient had been in vigorous health 8 months earlier when he experienced the onset of a febrile presentation with prostration, intermittent posterior‐located headache, severe arthromyalgia, and intense residual fatigue. Despite the lack of anorexia, the patient acknowledged an involuntary progressive weight loss accounted to 1 kg/month. Five months later, he developed recurrent insomnia episodes accompanied with dermatologic manifestations owing for a diffuse, blanching, macular rash located on the two arms and on the trunk. Simultaneously, an intense pruritus of the trunk aggravating an acute paravertebral paresthesia sensation was noted. Three weeks before admission, he developed laterocervical lymphadenopathies accompanied by a raise of the body temperature as high as 41°C. The patient is a French man working in Central Africa for 15 years. He had successively lived in Congo, Cameroon, Guinea, and then in Gabon and worked in rural forest areas. He had been diagnosed 4 years before for infection with the filarial worm Loa loa and was …