Universidade de São Paulo, Departamento de Doenças Infecciosas e Parasitárias, São Paulo, SP, Brasil.
Universidade de São Paulo, Departamento de Patologia, São Paulo, SP, Brasil.
Rev Soc Bras Med Trop. 2020 Jan 27;53:e20190380. doi: 10.1590/0037-8682-0380-2019. eCollection 2020.
Tegumentary leishmaniasis (TL) diagnosis is challenging due to the lack of a gold standard diagnostic tool. The diagnosis is significantly harder in regions where visceral leishmaniasis (VL) is also prevalent since immunological tests may present cross-reactivity. A cirrhotic patient from an endemic Brazilian region for TL and VL presented with atypical cutaneous lesions, a usual clinico-laboratory feature of VL (including a positive rk39 test result), but he was diagnosed with TL histopathologically; VL was ruled out by necropsy. Physicians working in co-prevalent areas should be aware of atypical features, unusual clinical course, and unexpected laboratory findings of leishmaniasis.
皮肤利什曼病（TL）的诊断具有挑战性，因为缺乏金标准诊断工具。在内脏利什曼病（VL）也流行的地区，诊断更加困难，因为免疫试验可能会出现交叉反应。一名来自巴西 TL 和 VL 流行地区的肝硬化患者出现了非典型皮肤损伤，这是 VL 的常见临床-实验室特征（包括 rk39 试验阳性结果），但他被组织病理学诊断为 TL；通过尸检排除了 VL。在流行地区工作的医生应该注意利什曼病的非典型特征、不典型临床病程和意外的实验室发现。
