Miller Daniel D, Gilchrest Barbara A, Garg Amit, Goldberg Lynne J, Bhawan Jag
Dermatopathology Section, Department of Dermatology, Boston University School of Medicine, Boston, MA 02118, USA.
J Cutan Pathol. 2012 Mar;39(3):361-5. doi: 10.1111/j.1600-0560.2011.01833.x. Epub 2012 Jan 11.
Acute primary cutaneous leishmaniasis typically presents microscopically with a lymphohistiocytic infiltrate containing admixed plasma cells, parasitized macrophages and abundant organisms. Tuberculoid granulomatous changes may occur in the later phases of primary infection. A 23-year-old male presented 1 month after visiting Peru with classic clinical findings of acute primary cutaneous leishmaniasis, while histopathology showed a tuberculoid granulomatous process that lacked any organisms in hematoxylin-eosin and fungal stains. Polymerase chain reaction (PCR) analysis and tissue cultures confirmed the diagnosis of cutaneous leishmaniasis with Leishmania (Viannia) panamensis infection. A pauci-organism tuberculoid granulomatous process may uncommonly be the presenting histopathology in the acute infectious phase of cutaneous leishmaniasis. Clinicians and dermatopathologists should be aware of this atypical presentation, which may cause diagnostic confusion and delay proper treatment. PCR testing should be employed in cases with high clinical suspicion when histopathology is not definitive.
急性原发性皮肤利什曼病在显微镜下通常表现为淋巴细胞组织细胞浸润，其中含有混合的浆细胞、被寄生的巨噬细胞和大量病原体。结核样肉芽肿性改变可能发生在原发性感染的后期。一名23岁男性在访问秘鲁1个月后出现急性原发性皮肤利什曼病的典型临床症状，而组织病理学显示为结核样肉芽肿过程，苏木精-伊红染色和真菌染色未发现任何病原体。聚合酶链反应（PCR）分析和组织培养确诊为巴拿马利什曼原虫感染的皮肤利什曼病。在皮肤利什曼病的急性感染期，少见的以少量病原体为主的结核样肉芽肿过程可能是最初的组织病理学表现。临床医生和皮肤病理学家应意识到这种非典型表现，其可能导致诊断混淆并延误恰当治疗。当组织病理学不明确时，对于临床高度怀疑的病例应采用PCR检测。
