Sharma Rohit, Singh Deepti, Muthukumaravel S, Hoti S L, Chandrashekar Laxmisha, Rahi Manju
Indian Council of Medical Research-Vector Control Research Center, Puducherry 605006, India.
Department of Dermatology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry 605006, India.
Pathogens. 2025 Apr 30;14(5):436. doi: 10.3390/pathogens14050436.
Cutaneous leishmaniasis (CL) is a significant public health concern that affects many countries. This disease is caused by the protozoan parasite spp. and is transmitted through the sandflies from the genus and . The clinical manifestations of CL can vary, often leading to challenges in accurate diagnosis and treatment. In 2022, a 51-year-old male patient presented to a tertiary care hospital in Puducherry, India, with progressively worsening facial lesions and granulomatous plaques. The patient had recently returned from Saudi Arabia, where he likely contracted the infection. Before he visited the tertiary care hospital in Puducherry, the patient had been misdiagnosed and treated for conditions such as Erysipelas and Acute Cutaneous Lupus Erythematosus (ACLE), highlighting the diagnostic challenges associated with CL. Skin scrapings from the patient were subjected to real-time PCR, confirming spp.'s presence. Cytological examinations revealed the amastigote-like structures within macrophages, thereby establishing the identity of the parasite. For precise species-level identification, PCR-Restriction Fragment Length Polymorphism (PCR-RFLP) and Sanger sequencing of the Internal Transcribed Spacer-1 (ITS-1) region were performed. Molecular techniques confirmed the infection as being caused by . Following the accurate diagnosis, the patient was successfully treated with Liposomal Amphotericin B, a treatment known for its efficacy against infections. This case underscores the critical importance of considering cutaneous leishmaniasis in the differential diagnosis of travelers returning from endemic areas who present with dermatological manifestations. The initial misdiagnosis and inappropriate treatment highlight the need for heightened clinical awareness and the utilization of advanced diagnostic tools for accurate identification. Effective and timely treatment, as demonstrated in this case, is essential for the management and control of the disease. This report emphasizes the necessity of vigilance among healthcare providers to recognize and appropriately address imported cases of cutaneous leishmaniasis.
皮肤利什曼病（CL）是一个影响许多国家的重大公共卫生问题。这种疾病由原生动物寄生虫属的物种引起，通过白蛉属和属的沙蝇传播。CL的临床表现可能各不相同，常常给准确诊断和治疗带来挑战。2022年，一名51岁男性患者前往印度本地治里的一家三级护理医院就诊，面部病变和肉芽肿性斑块逐渐加重。该患者最近从沙特阿拉伯返回，很可能在那里感染。在他前往本地治里的三级护理医院之前，该患者曾被误诊并接受过丹毒和急性皮肤红斑狼疮（ACLE）等疾病的治疗，凸显了与CL相关的诊断挑战。对患者的皮肤刮片进行实时PCR检测，证实了属物种的存在。细胞学检查发现巨噬细胞内有似无鞭毛体结构，从而确定了寄生虫的身份。为了进行精确的物种水平鉴定，对内部转录间隔区-1（ITS-1）区域进行了PCR-限制性片段长度多态性分析（PCR-RFLP）和桑格测序。分子技术证实感染是由引起的。准确诊断后，患者成功接受了脂质体两性霉素B治疗，这种治疗方法以其对感染的疗效而闻名。该病例强调了在对有皮肤表现的来自流行地区的旅行者进行鉴别诊断时考虑皮肤利什曼病的至关重要性。最初的误诊和不恰当治疗凸显了提高临床意识以及利用先进诊断工具进行准确识别的必要性。如本病例所示，有效及时的治疗对于疾病的管理和控制至关重要。本报告强调了医疗保健提供者保持警惕以识别和妥善处理输入性皮肤利什曼病病例的必要性。
