Development of Cutaneous Leishmaniasis after Leishmania Skin Test
Thirty-year-old female with a previous history of a cutaneous ulcer suspicious of leishmaniasis 20 years ago presented with a new complaint of a depressed papular lesion 8×7 mm in the right lower extremity. The lesion was of 10-day duration. Because early cutaneous leishmaniasis (CL) lesions may hav...
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| Language: | English |
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Wiley
2011-01-01
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| Series: | Case Reports in Medicine |
| Online Access: | http://dx.doi.org/10.1155/2011/631079 |
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| author | Paulo R. Machado Augusto M. Carvalho Gustavo U. Machado Marina L. Dantas Sérgio Arruda |
| author_facet | Paulo R. Machado Augusto M. Carvalho Gustavo U. Machado Marina L. Dantas Sérgio Arruda |
| author_sort | Paulo R. Machado |
| collection | DOAJ |
| description | Thirty-year-old female with a previous history of a cutaneous ulcer suspicious of leishmaniasis 20 years ago presented with a new complaint of a depressed papular lesion
8×7 mm in the right lower extremity. The lesion was of 10-day duration. Because early cutaneous leishmaniasis (CL) lesions may have a non-ulcerated appearance, a Leishmania skin test (LST) was performed on the forearm with a strong positive result (38×32 mm). After 8 days, the lesion in the leg, which was diagnosed as folliculitis, completely healed. However, a typical CL ulcer (26×24 mm) developed at the LST site. Histopathology of the new lesion did not identifiy parasites, but the findings were consistent with a diagnosis of CL. Further analysis identified amastigotes by immunohistochemical stain. Mononuclear cells harvested from the patient were stimulated with Leishmania antigen and showed high levels of production of both tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ): 2,943 pg/mL and 2,313 pg/mL, respectively. After 40 days of treatment with antimony and pentoxifylline, the ulcer resolved. The development of CL at the LST site suggests a strong Th1 immune response, and it is an in vivo documentation of the role of the host immune response in the pathology of CL. It teaches us that LST should be cautiously, if at all, used in patients with self-healing CL ulcers. |
| format | Article |
| id | doaj-art-94d8bc59221543f99962a40cda870551 |
| institution | Kabale University |
| issn | 1687-9627 1687-9635 |
| language | English |
| publishDate | 2011-01-01 |
| publisher | Wiley |
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| series | Case Reports in Medicine |
| spelling | doaj-art-94d8bc59221543f99962a40cda8705512025-02-03T01:29:05ZengWileyCase Reports in Medicine1687-96271687-96352011-01-01201110.1155/2011/631079631079Development of Cutaneous Leishmaniasis after Leishmania Skin TestPaulo R. Machado0Augusto M. Carvalho1Gustavo U. Machado2Marina L. Dantas3Sérgio Arruda4Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, BA 40000, BrazilCursos de Medicina e Biomedicina, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA 40000, BrazilCursos de Medicina e Biomedicina, Escola Bahiana de Medicina e Saúde Pública, Salvador, BA 40000, BrazilCentro de Pesquisas Gonçalo Moniz, LASP, Fundação Oswaldo Cruz, Salvador, BA 40000, BrazilCentro de Pesquisas Gonçalo Moniz, LASP, Fundação Oswaldo Cruz, Salvador, BA 40000, BrazilThirty-year-old female with a previous history of a cutaneous ulcer suspicious of leishmaniasis 20 years ago presented with a new complaint of a depressed papular lesion 8×7 mm in the right lower extremity. The lesion was of 10-day duration. Because early cutaneous leishmaniasis (CL) lesions may have a non-ulcerated appearance, a Leishmania skin test (LST) was performed on the forearm with a strong positive result (38×32 mm). After 8 days, the lesion in the leg, which was diagnosed as folliculitis, completely healed. However, a typical CL ulcer (26×24 mm) developed at the LST site. Histopathology of the new lesion did not identifiy parasites, but the findings were consistent with a diagnosis of CL. Further analysis identified amastigotes by immunohistochemical stain. Mononuclear cells harvested from the patient were stimulated with Leishmania antigen and showed high levels of production of both tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ): 2,943 pg/mL and 2,313 pg/mL, respectively. After 40 days of treatment with antimony and pentoxifylline, the ulcer resolved. The development of CL at the LST site suggests a strong Th1 immune response, and it is an in vivo documentation of the role of the host immune response in the pathology of CL. It teaches us that LST should be cautiously, if at all, used in patients with self-healing CL ulcers.http://dx.doi.org/10.1155/2011/631079 |
| spellingShingle | Paulo R. Machado Augusto M. Carvalho Gustavo U. Machado Marina L. Dantas Sérgio Arruda Development of Cutaneous Leishmaniasis after Leishmania Skin Test Case Reports in Medicine |
| title | Development of Cutaneous Leishmaniasis after Leishmania Skin Test |
| title_full | Development of Cutaneous Leishmaniasis after Leishmania Skin Test |
| title_fullStr | Development of Cutaneous Leishmaniasis after Leishmania Skin Test |
| title_full_unstemmed | Development of Cutaneous Leishmaniasis after Leishmania Skin Test |
| title_short | Development of Cutaneous Leishmaniasis after Leishmania Skin Test |
| title_sort | development of cutaneous leishmaniasis after leishmania skin test |
| url | http://dx.doi.org/10.1155/2011/631079 |
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