Serviço de Doenças Infeciosas. Centro Hospitalar Universitário do Porto. Porto. Portugal.
Serviço de Dermatologia. Centro Hospitalar Universitário do Porto. Porto. Portugal.
Acta Med Port. 2023 Dec 4;36(12):841-845. doi: 10.20344/amp.19446. Epub 2023 Oct 13.
Species associated with visceral leishmaniasis, such as L. infantum, may be responsible for cutaneous leishmaniasis (CL), particularly in the Mediterranean region. In immunosuppressed hosts, classification as complicated CL is essential, as the risk of mucosal leishmaniasis warrants systemic therapy. We report the case of a forty-seven-year-old male living in Portugal, with Fabry disease and receiving immunosuppressive treatment with adalimumab and methotrexate for Crohn's disease. There was no travel history outside of Europe. He presented a two-year-old, 5.5 cm plaque with a well-defined hyperkeratotic elevated border and central, painless ulceration on his back. The biopsy revealed parasites inside macrophages suggestive of Leishmania, and PCR identified the species as L. infantum. A biopsy via nasal endoscopy excluded mucosal involvement. Classification as complicated CL dictated treatment with liposomal amphotericin B and subsequent topical paramomycin. The rarity of CL in Portugal may delay its diagnosis, especially in autochthonous infections. Treatment choice is complicated by the heterogeneity of drugs available worldwide. As the global prevalence of CL increases, it is important to be aware of this diagnosis.
内脏利什曼病相关物种，如 L. infantum，可能与皮肤利什曼病（CL）有关，特别是在地中海地区。在免疫抑制宿主中，将其分类为复杂型 CL 至关重要，因为黏膜利什曼病的风险需要全身治疗。我们报告了一例 47 岁男性的病例，他居住在葡萄牙，患有法布瑞病，并因克罗恩病接受阿达木单抗和甲氨蝶呤免疫抑制治疗。他没有欧洲以外的旅行史。他背部有一个两年大的、5.5 厘米的斑块，边界清晰的角化过度隆起，中央无痛性溃疡。活检显示巨噬细胞内有寄生虫，提示为利什曼原虫，PCR 鉴定为 L. infantum 物种。鼻内镜活检排除了黏膜受累。复杂型 CL 的分类决定了使用脂质体两性霉素 B 进行治疗，随后使用局部巴龙霉素。葡萄牙 CL 的罕见性可能会延迟其诊断，尤其是在本地感染中。由于全球可用药物的异质性，治疗选择变得复杂。随着 CL 全球患病率的增加，了解这种诊断非常重要。
