Blum J, Junghanss T, Hatz C
Schweizerisches Tropeninstitut, Medizinische Abteilung, Basel.
Schweiz Rundsch Med Prax. 1994 Sep 13;83(37):1025-9.
Cutaneous leishmaniasis is an uncommon finding among patients seen in Central Europe. We report on three patients with cutaneous leishmaniasis who were initially misdiagnosed. Case 1, a woman who had returned from South America, was first thought to have an ulcer due to immunosuppression. Spread of the lesions to the nasal mucosa and a cosmetically disturbing scar were partly caused by delayed diagnosis and treatment. Case 2 shows a patient who has developed red papules on both legs after a trip to Spain. The lesions were misinterpreted as a residual reaction to insect bites. In case 3, a patient who had travelled in Nicaragua, the diagnosis of leishmaniasis was delayed because of coexisting acne vulgaris. In all three patients the final diagnosis of cutaneous leishmaniasis was confirmed by culture of the parasite. The only case with positive serology was the patient with mucocutaneous involvement. Two patients were radically cured, and one patient showed a substantial improvement of the lesions. The importance of a broad history including previous travel is emphasized to avoid the fallacies of missing a rare, but important disease among people travelling to countries with endemic leishmaniasis.
皮肤利什曼病在中欧就诊的患者中并不常见。我们报告了3例最初被误诊的皮肤利什曼病患者。病例1是一名从南美洲回来的女性，最初被认为患有因免疫抑制导致的溃疡。病变扩散至鼻黏膜以及出现影响美观的瘢痕，部分原因是诊断和治疗延误。病例2展示了一名在前往西班牙旅行后双腿出现红色丘疹的患者。这些病变被误诊为昆虫叮咬后的残留反应。病例3中，一名曾在尼加拉瓜旅行的患者，由于同时患有寻常痤疮，利什曼病的诊断被延误。在所有3例患者中，通过寄生虫培养确诊为皮肤利什曼病。唯一血清学呈阳性的病例是伴有黏膜皮肤受累的患者。2例患者被彻底治愈，1例患者的病变有显著改善。强调详细询问包括既往旅行史在内的病史对于避免误诊这种罕见但重要的疾病的重要性，这些疾病在前往利什曼病流行国家旅行的人群中时有发生。
