American Cutaneous Leishmaniasis: A Pleomorphic Disease with Unusual Clinical Presentations - Report of Three Cases

Background: Cutaneous leishmaniasis (CL) is an infectious disease caused by a protozoan of the genus Leishmania and is transmitted by the anopheline mosquito. This study focused on describe three cases of atypical clinical presentations on patients with American cutaneous leishmaniasis from Dermatology Department of the State University of the State of Pará.  Methods and Findings: Three patients assisted at a referral service between 2017 and 2019 are reported, based on clinical interview, histopathological analysis and polymerase chain reaction. On the first patient, it was observed keratotic erythematous vegetative plaque measuring 10x8 cm, with satellite lesions, in the left lower limb; the second patient presented an erythematous infiltrated plaque with crusts, on left ear for 6 months, with progressive growth; the third patient showed erythematous infiltrated plaques, sometimes ulcerated, in the trunk and face, with a zosteriform aspect. All three patients had the diagnosis confirmed by polymerase chain reaction and histopathological analysis. Conclusions: The wide range of clinical manifestations may be related to factors such as: use of immunosuppressive drugs, concomitant infections with more than one variety of Leishmania spp. and association with other systemic diseases, with HIV co-infection and diabetes being the main associated diseases. Thus, it is always necessary to evaluate such comorbidities on patients with leishmaniasis suspection, in order to avoid misdiagnosis.