Goodrich Eric S, Sears Stephen C, Sorrells Timothy, Radike James K, Miladi Anis, Glass Jonathan S
Graduate Medical Education, Naval Medical Center Portsmouth, 620 John Paul Jones Circle Portsmouth, VA 23708.
Department of Pathology, Naval Medical Center Portsmouth, 620 John Paul Jones Circle Portsmouth, VA 23708.
Mil Med. 2017 Jul;182(7):e1969-e1972. doi: 10.7205/MILMED-D-17-00054.
Cutaneous leishmaniasis typically presents as a painless papule progressing to an ulcer or plaque. In this case study of the ear, the disease manifested as a small painful bump progressing into redness and swelling about the ear with purulent drainage. After multiple oral/intravenous antipseudomonal, antistaphylococcal, and antifungal treatments, there was no improvement. The skin progressed to an erythematous plaque and hemorrhagic ulcer; punch biopsy and speciation revealed Leishmaniasis guyanensis. The patient was switched to a seven-dose course of intravenous L-amphotericin B (visceral leishmaniasis protocol). Within 21 days, pain and edema resolved and the ulcers healed. Three-month follow-up demonstrated no recurrence. Further studies are needed to evaluate the use of L-amphotericin B in Leishmaniasis guyanensis.
皮肤利什曼病通常表现为无痛性丘疹，进而发展为溃疡或斑块。在这个耳部病例研究中，该病表现为一个小的疼痛性肿块，随后耳部周围出现红肿并伴有脓性分泌物。经过多次口服/静脉注射抗假单胞菌、抗葡萄球菌和抗真菌治疗后，病情没有改善。皮肤发展为红斑性斑块和出血性溃疡；穿刺活检和菌种鉴定显示为圭亚那利什曼原虫。患者改用七剂静脉注射L-两性霉素B（内脏利什曼病治疗方案）。在21天内，疼痛和水肿消退，溃疡愈合。三个月的随访显示没有复发。需要进一步研究评估L-两性霉素B在圭亚那利什曼病中的应用。
