Department of Dermatology, Charles Nicolle Hospital, Boulevard 9 Avril, 1006 Tunis, Tunisia.
Dermatol Ther (Heidelb). 2011 Dec;1(2):36-41. doi: 10.1007/s13555-011-0008-9. Epub 2011 Nov 18.
Lupoid cutaneous leishmaniasis (CL) is a rare form of CL having a striking resemblance to other granulomatous cutaneous conditions of infectious or inflammatory origin. The authors present a patient with a facial lupoid CL and discuss the diagnostic tools of this parasitological infection, the main differential diagnosis, and treatment.
A 54-year-old Tunisian woman, with no past medical history of lupus erythematosus or infectious disease, presented with a 3-month history of a slowly enlarging erythematous and infiltrated plaque, extending over the nose, the right cheek, and the internal aspect of the right lower eyelid. Microscopic examination of a parasitological smear showed numerous leishmania in their amastigote form, inside monocytes, confirming the diagnosis of CL. Clinical aspect was in favor of lupoid CL. The patient was cured by fluconazole 200 mg/day for 6 weeks after pancreatic intolerance with intramuscular meglumine antimoniate (60 mg/kg/day for 7 days), and no response to doxycycline (200 mg/day for 6 weeks).
Lupoid CL is easily suspected in countries in which there is an endemic of leishmaniasis. In countries where there isn't an endemic, although rarely observed, this diagnosis should also be kept in mind in front of an infiltrated facial lesion of a tuberculoid aspect on histology, especially when there is a positive travel history to an area in which there is an endemic.
狼疮样皮肤利什曼病（CL）是一种罕见的 CL 形式，其特征与其他感染或炎症来源的肉芽肿性皮肤疾病非常相似。作者介绍了一名患有狼疮样面部 CL 的患者，并讨论了这种寄生虫感染的诊断工具、主要鉴别诊断和治疗方法。
一名 54 岁的突尼斯妇女，无红斑狼疮或传染病的既往病史，出现了 3 个月的缓慢扩大的红斑和浸润性斑块，延伸至鼻子、右脸颊和右下眼睑内侧。寄生虫涂片的显微镜检查显示大量处于无鞭毛体形式的利什曼原虫，在单核细胞内，证实了 CL 的诊断。临床方面倾向于狼疮样 CL。患者因胰腺不耐受而改用氟康唑 200 mg/天，共 6 周（肌肉内葡甲胺锑酸盐 60 mg/kg/天，共 7 天），在使用多西环素（200 mg/天，共 6 周）后无反应，最终治愈。
在利什曼病流行的国家，狼疮样 CL 很容易被怀疑。在没有流行的国家，尽管很少观察到，但在组织学上表现为结核样浸润性面部病变时，也应考虑到这种诊断，特别是当有前往流行地区的阳性旅行史时。
