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Portuguese Journal of Dermatology and Venereology

versão impressa ISSN 2795-501Xversão On-line ISSN 2795-5001

Port J Dermatol Venereol. vol.82 no.2 Lisboa jun. 2024  Epub 20-Dez-2023

https://doi.org/10.24875/pjdv.23000088 

DERMATOLOGY IMAGES

Disseminated cutaneous leishmaniasis due to Leishmania guyanensis in an infant

Leishmaniose cutânea disseminada por Leishmania guyanensis em recém-nascido

Isabella C. Mendes-Alexandre1  * 

Antônio P. Mendes-Schettini2 

Felipe J. de Araújo-Santos3 

Gabriel P. Seabra-Nunes4 

Gabriela Evangelista-de Almeida5 

Jorge A. de Oliveira-Guerra6 

Matheus Alecrim-Alexandre7 

Rosilene Viana-de Andrade8 

Luciana Mendes-dos Santos9 

1Division of Dermatology, Hospital Universitário Getúlio Vargas, Manaus

2Department of Pathology, Fundação Alfredo da Matta (FUAM), Manaus

3Department of Mollecular Biology, Fundação Alfredo da Matta (FUAM), Manaus

4Division of Internal Medicine, Instituto de Assistência Médica ao Servidor Público do Estado (IAMSPE), São Paulo

5Division of Dermatology, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus

6Division of Leishmaniasis and Infectology, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus

7Division of General Surgery, Hospital SAMEL, Manaus

8Department of Pathology, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus

9Department of Dermatology, Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD), Manaus. Brazil


A 5-month-old male toddler from Óbidos, Brazil, presented progressive erythematous-brown plaques and papules on the face and limbs since he was 2 weeks old (Figs. 1A, B and C). Leishmania amastigote was confirmed through a skin biopsy (Fig. 2), being confirmed Leishmania Viannia guyanensis in DNA amplification technique using polymerase chain reaction.

Figure 1 Lesions observed in the first outpatient visit. A: erythematous violaceous ulcerative plaques with crusts on the right arm. B: infiltrated and ulcerated plaque with erythematous violaceous edges on the left thigh. C: erythematous framed ulcerated lesion on the malar region. 

Figure 2 Histopathology from a skin lesion on the right arm demonstrating vacuolated histiocytes containing amastigotes of leishmania inside (H&E 100×). 

Initial treatment with intravenous pentavalent antimonial 1 mg/kg/day caused fever and tonic-clonic seizures, leading to a switch to pentamidine 4 mg/kg intramuscularly once a week for 3 weeks. The patient showed satisfactory resolution of symptoms 1 week after the last dose of pentamidine. The skin lesions evolved as definitive atrophic scars after the treatment (Fig. 3A, B and C).

Figure 3 A-C: satisfactory response after completing treatment with three doses of pentamidine. 

Cutaneous leishmaniasis (CL) has diverse clinical presentations and can be challenging when the clinical presentation is different from the classic ulcerated form1. In the neonatal period, CL often mimics other conditions, such as histiocytosis, lymphomas, and syphilis2,3. CL commonly affects children aged 2-12 years, corresponding to 10% of cases in endemic areas2,4.

Treatment of pediatric CL has higher rates of therapeutic failure compared to adults, depending on differences in the immune response and medication tolerance that contribute to this disparity4. In addition, children have poor tolerance to systemic medications, which may be common and potentially serious adverse events4,5.

Combination therapies, such as paromomycin, imiquimod, and amphotericin B, are being studied for optimal outcomes and reduced side effects5. The use of pentamidine for L. guyanensis infections is recommended, although off-label for children under 2 years old.

Although the reported case showed positive response and tolerability to pentamidine, further research is needed to improve CL treatment and minimize complications, aiming to reduce deformities and risks for affected patients.

References

1. De Vries HJ, Schallig HD. Cutaneous leishmaniasis:a 2022 updated narrative review into diagnosis and management developments. Am J Clin Dermatol. 2022;23:823-40. [ Links ]

2. De Azeredo-Coutinho RB, Mendonça SC. Formas clínicas das leishmanioses tegumentares nas Américas. In:Leishmanioses Do Continente Americano. DGODigital Original. Rio de Janeiro:SciELO, Editora FIOCRUZ;2014. 311-26. [ Links ]

3. Fikre H, Teklehaimanot E, Mohammed R, Mengistu M, Abebe B, Van Griensven J, et al. Atypical mucocutaneous leishmaniasis presentation mimicking rectal cancer. Case Rep Infect Dis. 2023;2023:2768626. [ Links ]

4. Uribe-Restrepo A, Cossio A, Desai MM, Dávalos D, Castro MD. Interventions to treat cutaneous leishmaniasis in children:a systematic review. PLoS Negl Trop Dis. 2018;12:e0006986. [ Links ]

5. Azim M, Khan SA, Ullah S, Ullah S, Anjum SI. Therapeutic advances in the topical treatment of cutaneous leishmaniasis:a review. PLoS Negl Trop Dis. 2021;15:e0009099. [ Links ]

FundingNone.

Ethical disclosures

Protection of human and animal subjects. The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data. The authors declare that they have followed the protocols of their work center on the publication of patient data.

Right to privacy and informed consent. The authors have obtained the written informed consent of the patients or subjects mentioned in the article. The corresponding author is in possession of this document.

Use of artificial intelligence for generating text. The authors declare that they have not used any type of generative artificial intelligence for the writing of this manuscript, nor for the creation of images, graphics, tables, or their corresponding captions.

Received: October 25, 2023; Accepted: November 11, 2023

*Correspondence: Isabella Mendes-Alexandre E-mail: bellac_mendes@hotmail.com

Conflicts of interest

None.

Creative Commons License Portuguese Society of Dermatology and Venereology. Published by Permanyer. This is an open access article under the CC BY-NC-ND license