Department of Pathology, Medical Faculty, Ege University, Izmir, Turkey.
Department of Dermatology, Medical Faculty, Ege University, Izmir, Turkey.
J Cutan Pathol. 2021 Jun;48(6):807-810. doi: 10.1111/cup.14006. Epub 2021 Mar 21.
Cutaneous leishmaniasis (CL) is an intracellular parasitic infectious skin disease with a chronic self-limited course. In vivo reflectance confocal microscopy (RCM) findings in CL have been described in only two cases of CL. We report another case with RCM findings; however to our knowledge, this is the first demonstration of Leishmania amastigotes in RCM imaging. A centrally eroded reddish nodular lesion with a diameter of 12 mm was observed on the leg of a 36-years-old male with a 1-month history. On dermoscopy, a central yellowish crust, and irregularly distributed whitish opaque structures ranging in size and shape (round to polygonal) were observed. There were also irregular vessels mostly at the center and dotted/glomerular vessels at the periphery. On RCM, mild epidermal disarray with some scattered bright cells at the basal layer was observed. At the dermis, dense infiltration of polymorphic/roundish cells with heterogeneous reflectivity was seen. These large, mildly reflecting cells with fine granular structures in their cytoplasm were compatible with macrophages. Histopathology was concordant with CL. The Leishmania amastigotes seen as cytoplasmic granularity on RCM were the clue feature for the initial diagnosis.
皮肤利什曼病（CL）是一种具有慢性自限性的细胞内寄生性传染性皮肤疾病。CL 的体内反射共聚焦显微镜（RCM）检查结果仅在两例 CL 中有所描述。我们报告了另一个具有 RCM 检查结果的病例；然而据我们所知，这是首次在 RCM 成像中显示利什曼无鞭毛体。一名 36 岁男性腿部出现直径为 12mm 的中央侵蚀性红色结节性病变，病史 1 个月。在皮肤镜下，观察到中央黄色鳞屑，以及大小和形状不规则分布的白色不透明结构（圆形至多边形）。还有不规则的血管，主要位于中央，点状/团块状血管位于周边。在 RCM 下，观察到轻度表皮排列紊乱，基底层有一些散在的明亮细胞。在真皮层，可见密集的多形性/圆形细胞浸润，反射性不均匀。这些大的、轻度反射的细胞，其细胞质中具有精细的颗粒状结构，与巨噬细胞一致。组织病理学与 CL 一致。RCM 上看到的呈细胞质颗粒状的利什曼无鞭毛体是初步诊断的特征性线索。
