Chronic Cutaneous-Visceral Leishmaniasis: A Forgotten Differential Diagnosis

Abstract

Leishmaniasis is a vector-borne disease. Three types of manifestations are recognized in the literature: Cutaneous, Mucocutaneous, and Visceral. The transmission and infection mechanism begins when the sandfly feeds on blood and regurgitates promastigotes into the skin, which are phagocytosed by macrophages. The diagnosis is based on clinical features and laboratory tests, such as direct parasitological examination, to increase diagnostic accuracy. Regarding the first case of Visceral Leishmaniasis in the state of Guerrero. An 18-year-old man with unspecified dermatitis since the age of 8, which began with an unquantified, intermittent fever, predominantly in the evening. On the fourth day, the patient presented edema in the auricles, itching, erythema, and increased local temperature that evolved into a papule and blister, with the formation of an indurated scab that, when detached, leaves an ulcer. This invades subcutaneous cellular tissue and disappears after 6 weeks, leaving an atrophic scar. This scar has occurred at least 6 times a year for 9 years, alternating between the auricles, elbows, and ankles. The patient therefore came for medical evaluation with an ulcer on the inner side and upper third of the left leg with an increase in diameter, edema, and a necrotic ulcer with purulent and foul-smelling discharge. A wound smear was requested, which was stained with Giemsa and found Leishmania spp. PCR with specific oligonucleotides: Mexican visceral Leishmania. After confirming the diagnosis of the disseminated mucocutaneous variant, it was decided to initiate systemic and local intralesional treatment with systemic antimonial. During follow-up, the patient observed scleroatrophic healing of previously ulcerated lesions, with no signs of infection or new lesions. It is important to understand leishmaniasis as a differential diagnosis for ulcerated lesions of variable distribution with a short or chronic course, and to perform the necessary studies to achieve appropriate treatment and improve the patient's prognosis.