Lymphadenopathy as the first sign of human cutaneous infection by Leishmania braziliensis.

This paper describes the presence of transitory lymphadenopathy as an initial sign of cutaneous leishmaniasis, and sometimes the only manifestation of Leishmania braziliensis infection. Ten patients with lymphadenopathy living in an area of L. braziliensis transmission had Leishmania cultivated from their lymph nodes previous to any other manifestation of cutaneous leishmaniasis. Seven of the 10 developed leishmanial ulcers later in the course of infection, whereas lymphadenopathy regressed in three cases and no other sign of infection developed. Results of tests for anti-Leishmania antibodies and an intradermal skin test were positive in four and five patients, respectively, at the time of the diagnosis. The documentation of Leishmania amastigotes in the lymph nodes before any clinical evidence of cutaneous disease indicates that early spread of L. braziliensis from the skin to lymph nodes occurs before a local lesion develops. All medical doctors examining patients coming from endemic areas of leishmaniasis should be aware that lymph node enlargement, even in the absence of a typical ulceration, may be indicative of leishmanial infection and warrants further investigation.