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Leishmaniasis of the Feet Sole: A Case Report: Leishmaniasis of the Feet Sole: Bir Olgu Sunumu.

ABSTRACT

Here we report the case of a patient with cutaneous leishmaniasis, who was referred to our clinic in Yazd, Iran. On examining the patient, who was a housekeeper, we found a small plaque in the palmoplantar region due to cutaneous leishmaniasis. She had not any history from an identical case in this patient. After treatment, the lesions improved.

Keywords: Cutaneous leishmaniasis, Palmoplantar, Iran

Received: 31.01.2016

Accepted: 13.02.2017

OZ

Bu calismada Iran, Yazd'da klinigimize yonlendirilen kutanoz leishmaniasisi olan bir hastayi sunmaktayiz. Temizlikci olarak calisan hastanin muayenesinde, palmoplantar bolgede deri leishmaniasisinden kaynaklanan kucuk bir plak saptandi. Hastanin ozdes bir vaka oykusu yoktu. Tedavi sonrasi lezyonlar iyilesti.

Anahtar Kelimeler: Kutanoz leishmaniasisi, Palmoplantar, Iran

Gelis Tarihi: 31.01.2016

Kabul Tarihi: 13.02.2017

INTRODUCTION

Leishmaniasis is a major problem in many parts of the world (1). The disease has different types from the self-limited and even self-healing cutaneous forms to fatal systemic disease (1, 2). Almost 1.5 million cases of cutaneous leishmaniasis (CL) are reported each year worldwide (1). The parasitic agent of leishmaniasis was discovered 100 years ago (2). Sandflies, being the vectors of these parasites, determine the frequency of CL; they mainly belong to the genus Phlebotomus or Lutzomyia (3). These species live in damp, dark areas (4). Sandflies get infected when they feed on infected animals (5). Once infected, they can transmit the parasite to both animals and humans (3, 4).

Cutaneous leishmaniasis lesions may develop in all parts of the body, but the most likely sites are the exposed areas (6). The primary papule rapidly transforms into an ulcer (7). Lesions are commonly unique and often self-healing (6). Some rare manifestations of CL have been described (3-5). Here we present an interesting case of CL because of the rare location of the lesion in the palmoplantar region.

CASE REPORT

A 36-year-old woman visited our hospital with a 3-month-old bite in the palmoplantar region (Figure 1). Initially, the lesion was and slowly expanded. She reported no history of trauma, drug intake, or allergies. Her occupation was housekeeping. In addition, the patient did not have a similar disease in the past. She also did not have any history of tuberculosis. She reported that she had no risk factors associated with human immunodeficiency virus (HIV) and no chills, pain, fever, or constitutional signs. A complete blood count, erythrocyte sedimentation rate, C-reactive protein, fasting blood glucose, and intradermal purified protein derivative skin test and serology for HIV were all within the normal ranges. On physical examination, a small lesion was found in the palmoplantar region (Figure 1).

There were no palpable lymphatic cords or lymph nodes. Stains and cultures were negative for acid-fast bacteria, fungi, and other bacteria. The patient resided in an endemic place and was therefore asked to undergo CL test. Wright-Giemsa's stain was positive for Leishmania. The patient was treated with meglumine antimoniate (glucantime), a pentavalent antimonial, at a dosage of 20 mg/kg per day intramuscularly for 20 days, as suggested by the Center for Disease Control in Iran. After therapy, the lesions improved.

The ethics committee of our university approved the study. The patient was not in accessible to get an informed consent.

DISCUSSION

Cutaneous leishmaniasis is an infection caused by a protozoan of the genus Leishmania and is transmitted by sandfly bites (3-7). Because of the thickness of the skin on the palms of hands and feet and the head, sandflies generally do not feed on these skin areas. After thirty years of working experience, this is the first case wherein we have encountered leishmaniasis on the palms of the hands. Classical signs and numerous atypical forms have been described, such as annular, chancriform, acute paronychial, palmoplantar, zosteriform, and erysipeloid (1, 3, 7-9).

CONCLUSION

The present case is interesting because of the rare location of the lesion in the palmoplantar region. Some atypical variants were already described, such as chancriform, palmoplantar, zosteriform, and erysipeloid, and more recently the paronychial, annular, eyelid, chancriform, zosteriform, and palmoplantar that palmoplantar region reports were very rare (1, 3, 5, 7-9).

Informed Consent: Informed consent couldn't be obtained due to impossibility to reaching the patient.

Peer-review: Externally peer-reviewed.

Author contributions: Concept - J.A.; Design - J.A., A.F.B.; Supervision - J.A.; Resource - S.H.S.; Materials - S.H.S.; Data Collection and/or Processing - S.H.S.; Analysis and /or Interpretation - S.H.S.; Literature Search - J.A., S.H.S.; Writing - S.H.S.; Critical Reviews - J.A., A.F.B., S.H.S.

Acknowledgements: The authors would like to thank Infectious Diseases Research Center of Yazd Shahid Sadoughi University of Medical Sciences for their kind assistance in performing this study.

Conflict of Interest: No conflict of interest was declared by the authors.

Financial Disclosure: The authors declared that this study has received no financial support.

Hasta Onami: Hastaya ulasilamadigindan dolayi hasta onami alinamamistir.

Hakem Degerlendirmesi: Dis Bagimsiz.

Yazar Katkilari: Fikir - J.A.; Tasarim - J.A. A.F.B.; Denetleme - J.A.; Kaynaklar - S.H.S.; Veri Toplanmasi ve/veya islemesi - S.H.S.; Analiz ve/veya Yorum - S.H.S.; Literatur taramasi - J.A., S.H.S.; Yaziyi Yazan - S.H.S.; Elestirel Inceleme - J.A., A.F.B., S.H.S.

Tesekkur: Yazarlar, calismanin gerceklesmesine bulunduklari nazik katkilar icin Yazd Shadid Sadoughi Tibbi Bilimler Universitesi Bulasici Hastaliklar Arastirma Merkezi'ne tesekkur ederler.

Cikar Catismasi: Yazarlar cikar catismasi bildirmemislerdir.

Finansal Destek: Yazarlar bu calisma icin finansal destek almadiklarini beyan etmislerdir.

REFERENCES

(1.) Ceyhan AM, Yildirim M, Basak PY, Akkaya VB, Erturan I. A case of erysipeloid cutaneous leishmaniasis: atypical and unusual clinical variant. Am J Trop Med Hyg 2008; 78: 406-8.

(2.) Bari AU, Rahman SB. Many faces of cutaneous leishmaniasis. Indian J Dermatol Venereol Leprol 2008; 74: 23-7. [CrossRef]

(3.) Ayatollahi J, Fattahi Bafghi A, Shahcheraghi SH. Chronic zoster-form: a rare variant of cutaneous leishmaniasis. Reviews in Medical Microbiol 2015; 26: 114-5. [CrossRef]

(4.) Ayatollahi J, Fattahi Bafghi A, Shahcheraghi SH. Rare variants of cutaneous leishmaniasis presenting as eczematous lesions. Med J Islam Repub Iran 2014; 28: 71.

(5.) Ayatollahi J, Ayatollahi A, Shahcheraghi SH. Cutaneous leishmaniasis of the eyelid: a case report. Case Rep Infect Dis 2013. [CrossRef]

(6.) Iftikhar N, Bari I, Ejaz A. Rare variants of Cutaneous Leishmaniasis: whitlow, paronychia, and sporotrichoid. Int J Dermatol 2003; 42: 807-9. [CrossRef]

(7.) Chiheb S, El Machbouh L, Marnissi F. Paronychia-like cutaneous leishmaniasis. Dermatol Online J 2015; 21.

(8.) Raja KM, Khan AA, Hameed A, Rahman SB. Unusual clinical variants of cutaneous leishmaniasis in Pakistan. Br J Dermatol 1998; 139: 111-3. [CrossRef]

(9.) Shamsuddin S, Mengal JA, Gazozai S, Mandokhail ZK, Kasi M, Muhammad N, et al. Atypical presentation of cutaneous leishmaniasis in native population of Baluchistan. J Pak Assoc Dermatol 2006; 16: 196-200.

Jamshid Ayatollahi (1), Ali Fattahi Bafghi (1), Seyed Hossein Shahcheraghi (1-2)

(1) Department of Infectious Diseases, Infectious Diseases Research Center, Shadid Sadoughi University of Medical Sciences, Yazd, Iran

(2) Department of Modern Sciences and Technologies, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Address for Correspondence / Yazy[thorn]ma Adresi: Seyed Hossein Shahcheraghi E.mail: shahcheraghih@gmail.com

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Article Details
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Author:Ayatollahi, Jamshid; Bafghi, Ali Fattahi; Shahcheraghi, Seyed Hossein
Publication:Turkish Journal of Parasitology
Article Type:Clinical report
Geographic Code:7IRAN
Date:Mar 1, 2017
Words:1228
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