Chiheb S, Oudrhiri L, Zouhair K, Soussi Abdallaoui M, Riyad M, Benchikhi H
Service de dermatologie-vénérologie, CHU Ibn Rochd, 1, Quartier des Hôpitaux, 20200 Casablanca, Maroc.
Ann Dermatol Venereol. 2012 Aug-Sep;139(8-9):542-5. doi: 10.1016/j.annder.2012.05.013. Epub 2012 Jun 21.
Cutaneous leishmaniasis (CL) is a parasitic infection characterized by significant clinical variability. Unusual and atypical clinical aspects of infection have been reported in immunodeficient patients or associated with particular parasite species. We report three cases of CL from foci of Leishmania major with a particular clinical presentation in diabetic patients.
Patient 1: a 37-year-old man was admitted to the dermatology department for cutaneous vegetative ulcers spreading to the dorsal surface of the foot. History-taking revealed a stay in Er-Rachidia (East of Morocco, a known focus of CL L. major) six weeks earlier. Diabetes mellitus type I was discovered during hospitalization. The patient's 43-year-old sister (patient 2), diabetic for 6 years, consulted for a single leg ulcer appearing 3 months after the same trip to Er-Rachidia. Patient 3: a 61-year-old patient with a 7-year history of diabetes and under oral antidiabetics presented an extended vegetative lesion of the posterior surface of the leg 2 months after staying in Er-Rachidia. A diagnosis of CL was retained on the basis of epidemiology and history (living in an endemic areas of leishmaniasis), coupled in patients 1 and 3 with microbiological evidence involving identification of Leishmania bodies in skin smears or skin biopsies. All patients were treated with two intra-lesional injections per week of meglumine antimony (Glucantime(®)) for 6 weeks. The outcome was marked in all cases by healing of lesions and persistent pigmented scarring.
We described three particular clinical aspect of CL emerging from a known focus of L. major, where infection is classically associated with vegetative or ulcero-vegetative lesions. This unusual profile suggests the role of factors related to parasite species and/or diabetes found in our three patients.
皮肤利什曼病（CL）是一种寄生虫感染，其临床症状具有显著变异性。免疫功能低下患者或与特定寄生虫种类相关的感染出现了不寻常和非典型的临床症状。我们报告了3例来自硕大利什曼原虫疫源地的CL病例，这些病例在糖尿病患者中具有特殊的临床表现。
患者1：一名37岁男性因皮肤增殖性溃疡蔓延至足背而入住皮肤科。病史询问显示，他六周前曾在埃尔拉希迪亚（摩洛哥东部，已知的硕大利什曼原虫疫源地）停留。住院期间发现患有I型糖尿病。患者43岁的姐姐（患者2），患糖尿病6年，在同一次前往埃尔拉希迪亚旅行3个月后因单腿溃疡前来咨询。患者3：一名61岁患者，有7年糖尿病病史，正在口服抗糖尿病药物，在埃尔拉希迪亚停留2个月后，腿部后侧出现了一个扩展的增殖性病变。根据流行病学和病史（生活在利什曼病流行地区），结合患者1和3的微生物学证据（在皮肤涂片或皮肤活检中鉴定出利什曼原虫体），确诊为CL。所有患者每周接受两次病灶内注射葡甲胺锑（葡酸锑钠（®）），共6周。所有病例的结果均为病变愈合和持续色素沉着瘢痕形成。
我们描述了3例CL的特殊临床症状，这些症状出现在已知的硕大利什曼原虫疫源地，在该疫源地，感染通常与增殖性或溃疡增殖性病变相关。这种不寻常的情况表明，我们3例患者中发现的寄生虫种类和/或糖尿病相关因素起到了作用。
