Akosman Sinan, Song Heeyah, Sheils Paul, Mansour Tamer, Wroblewski Keith J, Rajjoub Lamise
Department of Ophthalmology, George Washington University School of Medicine, 2150 Pennsylvania Avenue Suite 2A, Washington, DC, USA.
J Ophthalmic Inflamm Infect. 2024 Aug 23;14(1):41. doi: 10.1186/s12348-024-00423-z.
To report a rare non-endemic case of Leishmania aethiopica in Washington DC.
A 68-year-old female presented for a routine examination with a complaint of right upper eyelid lesions for the past 5 months. On examination, a cluster of elevated and erythematous lesions extending from the medial canthus to the brow area of the right eye were seen. Initial treatment with Valtrex based on a suspected viral etiology failed. Although a biopsy was recommended at this time, the patient declined, and subsequent workup included nasolacrimal duct irrigation, blood work to rule out autoimmune etiology, a course of doxycycline, and an MRI, which yielded no improvement. Upon progression of the lesions into persistent plaques on the eyelids, a punch biopsy was performed, confirming leishmaniasis. The patient was then started on a 28-day course of oral miltefosine which led to complete resolution of her symptoms.
This case underlines the importance of a broad differential including non-endemic diseases, particularly in urban areas with frequent patient travel. Furthermore, the delayed punch biopsy in this case highlights the importance of patient counseling to ensure prompt diagnosis and treatment.
报告华盛顿特区一例罕见的埃塞俄比亚利什曼原虫非地方性病例。
一名68岁女性因右眼睑病变5个月前来进行常规检查。检查时，可见一簇从内眦延伸至右眼眉区的隆起性红斑病变。基于疑似病毒病因，最初使用伐昔洛韦治疗无效。尽管此时建议进行活检，但患者拒绝，随后的检查包括鼻泪管冲洗、排除自身免疫病因的血液检查、多西环素疗程以及MRI检查，均未见改善。当病变进展为眼睑上的持续性斑块时，进行了打孔活检，确诊为利什曼病。随后患者开始接受为期28天的口服米替福新疗程，症状完全缓解。
该病例强调了广泛鉴别诊断的重要性，包括非地方性疾病，尤其是在患者频繁出行的城市地区。此外，该病例中延迟的打孔活检突出了患者咨询对于确保及时诊断和治疗的重要性。
