Disseminated cutaneous Leishmaniasis in a patient who is HIV positive with a flare up as iris -a case report
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2018, Vol 3, Issue 10
Abstract
There is a broad spectrum of clinical manifestations of cutaneous leishmaniasis. The usual lesion is a small, red papule which over several weeks becomes darker, crusts in the centre and eventually ulcerates & heals, leaving a raised border. A rare form is the disseminated (diffuse) cutaneous leishmaniasis which can occur among immunosuppressed persons where lesions begin with an initial primary lesion and then disseminates to involve other areas of the skin. The lesions are non ulcerative nodules full of parasites, and are often scattered over the limbs, buttocks, and face. The disease does not involve internal organs. 32 yrs old male presented with multiple swellings in different parts of body with itching. O/E multiple plaques, sub cutaneous nodules and molluscum like lesions were present over extremities and trunk. Biopsy from multiple sites was similar and suggestive of Leishmaniasis. Treated with sodium stibogluconate and lesions responded. 5 months after ART he presented with generalised plaques and oedematous red lesions resembling photo dermatitis. Repeat skin biopsy showed same picture. Treated with sodium stibogluconate again and for past 4yrs he is asymptomatic. Cutaneous leishmaniasis is caused by different species of genus Leishmania, a protozoon that is transmitted by sand-flies. The result of infection varies from a cutaneous ulcer, to erosive mucosal disease with severe facial disfigurement, to a life threatening systemic infection, depending upon the interaction between Leishmania and the genetic and immunological status of the host. Leishmaniasis and HIV co-infection may intensify the immune defect and is the chief reason for atypical presentation and widespread progression of cutaneous leishmaniasis and its defiance to conventional therapy. IRIS whether paradoxical worsening or unmasking form is very common event after initiation of HAART, especially if CD4 is very low. Paradoxical worsening of diffuse cutaneous Leishmaniasis is still very uncommon.
Authors and Affiliations
Dr Sheela Mathew
Keywords
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