Esfandiarpour I, Dabiri S H, Yousefi K
Department of Dermatology, Afzalipour Hospital, Kerman, Iran.
Int J Dermatol. 2007 Jul;46(7):711-4. doi: 10.1111/j.1365-4632.2007.02974.x.
Cutaneous leishmanisis (CL) is a common disease in Iran, particularly in Kerman and Bam and Kerman province. Lymphadenitis resulting from leishmania tropica (dry type) with, or without, cutaneous lesion is rare. Localized leishmanial lymphadenitis (LLA) is a specific clinico-pathologic presentation of inflammatory changes caused by leishmanial parasites or antigen within an isolated lymph node without any systemic manifestation.
A 55-year-old Iranian woman presented with two slow growing large nodules (masses) on the left preauricular and the left cervical areas. The nodules were large, painless, mobile, multilobulated, and associated with a small skin papule on the left-side of the cheek distal to the masses.
Histopathologic examination of both the skin lesion and the lymph nodes suggested the leishmanial etiology of skin papule and lymphadenitis. The Leishman-bodies (amastigotes) were demonstrated in two lymph nodes and a skin lesion. The clinical picture plus pathological finding and the response to meglumine-antimoniate confirmed LLA.
Lymph node involvement is another rare manifestation of dissemination of infection with dermotropic leishmania. This presentation of CL should not be treated with the ordinary local treatments such as curettage, cryotherapy or surgical excision.
皮肤利什曼病（CL）在伊朗是一种常见疾病，尤其是在克尔曼、巴姆及克尔曼省。由热带利什曼原虫（干性）引起的伴有或不伴有皮肤病变的淋巴结炎较为罕见。局限性利什曼性淋巴结炎（LLA）是利什曼原虫或抗原在单个淋巴结内引起炎症改变的一种特定临床病理表现，无任何全身表现。
一名55岁的伊朗女性，左耳前和左颈部出现两个生长缓慢的大结节（肿块）。这些结节较大、无痛、可活动、呈多叶状，且在肿块远端脸颊左侧伴有一个小皮肤丘疹。
对皮肤病变和淋巴结进行组织病理学检查提示皮肤丘疹和淋巴结炎的病因是利什曼原虫。在两个淋巴结和一个皮肤病变中均发现了利什曼小体（无鞭毛体）。临床表现、病理结果以及对葡甲胺锑酸盐的反应均证实为LLA。
淋巴结受累是嗜皮肤性利什曼原虫感染播散的另一种罕见表现。这种CL表现不应采用刮除、冷冻疗法或手术切除等普通局部治疗方法。
