Bormann G, William T, Schulz A, Marsch W, Gaber G
Universitätsklinik und Poliklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale).
Dtsch Med Wochenschr. 2003 Oct 2;128(40):2065-8. doi: 10.1055/s-2003-42703.
Three weeks after returning from a trip to Guatemala, a 33-year-old man developed two ulcers with indurated edges on his right leg and painful lymph nodes in the right groin. His general condition was not impaired.
Histological examination revealed cellular infiltrates of the corium by lymphocytes and plasma cells, always accompanied by epithelial cells and multinuclear giant cells. Special stainings were unable to detect pathogens but Leishmania brasiliensis was identified using PCR. The Leishmania culture remained negative.
After 7-day intravenous therapy with 20 mg/kg/d pentostam (pentavalent antimonial compound), the patient developed gastrointestinal complaints, coupled with a marked elevation of transaminases. Therapy was discontinued until the transaminase values normalized, then continued in reduced dosage (12 mg/kg body weight) for 23 days. The ulcers and lymphadenitis healed under this therapy.
The diagnosis of American cutaneous Leishmaniasis may be complicated by the relative lack of pathogens in the lesions. PCR diagnosis are very helpful here. The therapy must be systemic owing to the danger of progression to mucocutaneous Leishmaniasis. The standard therapeutic pentostam has, however, a high rate of side effects and administration is exclusively intravenous.
一名33岁男子在从危地马拉旅行归来三周后，右腿出现两处边缘硬结的溃疡，右侧腹股沟淋巴结疼痛。其一般状况未受影响。
组织学检查显示真皮层有淋巴细胞和浆细胞浸润，常伴有上皮细胞和多核巨细胞。特殊染色未检测到病原体，但通过聚合酶链反应（PCR）鉴定出巴西利什曼原虫。利什曼原虫培养结果为阴性。
患者接受20mg/kg/d喷他脒（五价锑化合物）静脉治疗7天后，出现胃肠道不适，转氨酶显著升高。治疗中断至转氨酶值恢复正常，然后以较低剂量（12mg/kg体重）继续治疗23天。在此治疗下，溃疡和淋巴结炎愈合。
美洲皮肤利什曼病的诊断可能因病变中病原体相对较少而复杂化。PCR诊断在此非常有帮助。由于有发展为黏膜皮肤利什曼病的风险，治疗必须是全身性的。然而，标准治疗药物喷他脒副作用发生率高，且只能静脉给药。
