Cutaneous leishmaniasis in an albino child: a peculiar presentation

Ahmed Samaouel Chehad, N. Boutrid, Hadjer Khouidmi, H. Rahmoune
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Abstract

Cutaneous leishmaniasis (CL) is the most common form of leishmaniasis. It is characterized by nodulo-ulcerative skin lesions and occasionally nodular, papular/plaque, and/or impetiginous lesions on exposed parts of the body. However, other atypical lesions of CL have been reported worldwide such as lupoid, eczematous, erysipeloid, verrucous, dry, zosteriform, paronychial, sporotrichoid, chancriform, annular and erythematous volcanic ulcers. These non-specific lesions often make the diagnosis challenging due to the large number of differential diagnoses and may lead to a delay in the implementation of CL therapy and therefore a higher risk of lifelong scars and major quality of life issues and stigma. We report a case of an 11-year-old immunocompetent albino child boy that presented with 3 years’ history of persistent multiple asymptomatic, small ulcers and cribriform scars of the forehead. Diagnosis of CL was confirmed by detecting Leishmania parasites in tissue specimens, and treatment by antimony drugs resulted in healing of lesion within one month. This is a novel case of a rare, atypical form of CL, which resulted in delayed diagnosis and management. Clinicians, especially those practicing in CL endemic areas like the Americas and the Mediterranean basin, should consider systematically the diagnosis of CL in front of long-lasting and/or non-specific lesions.
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白化病儿童皮肤利什曼病:一种特殊的表现
皮肤利什曼病(CL)是最常见的利什曼病。它的特征是结节性溃疡性皮肤病变,偶尔在身体暴露部位出现结节性、丘疹/斑块和/或脓疱性病变。然而,其他非典型的CL病变,如脂样、湿疹、丹毒样、疣状、干性、带状疱疹样、甲状、孢子毛状、软下疳、环状和红斑性火山溃疡,在世界范围内也有报道。由于大量的鉴别诊断,这些非特异性病变往往使诊断具有挑战性,并可能导致CL治疗实施的延迟,因此终身疤痕和主要生活质量问题和耻辱的风险更高。我们报告一个11岁的免疫能力白化病儿童男孩,提出了3年的历史,持续性多发性无症状,小溃疡和网状疤痕的额头。经组织标本检出利什曼原虫,确诊为CL,经锑药治疗,1个月内病灶愈合。这是一个罕见的,非典型形式的CL的新病例,导致延迟诊断和管理。临床医生,特别是在美洲和地中海盆地等CL流行地区执业的临床医生,应在长期和/或非特异性病变面前系统地考虑CL的诊断。
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