Leishmaniasis Recidiva Cutis: Intralesional Treatment and Surgical Aproach (original) (raw)
2018, Journal of Tropical Medicine and Health
Introduction: Leishmaniasis is parasitic disease caused by different species of Leishmania spp and transmitted by bites of phlebotomine sandflies. Tegumentary leishmaniasis affects the skin and may evolve with lesions on mucous membranes. The lesions are often seen in areas of the skin that are most exposed to insect bites, such as the legs, but there are cases described in various places in the body. In endemic areas, its diagnosis can be facilitated when skin lesions are ulcerations features with raised edges (framed) and the medical professional has experience in recognizing the disease. However, rare variants of the disease may hinder its diagnosis, such as Leishmaniasis Recidiva Cutis (LRC). This clinical form should be suspected in view of the appearance of new lesions in regions of previous scars of tegumentary leishmaniasis, or active lesions with poor response to conventional treatment. The gold standard diagnosis is the detection of the parasite in the tissue, however this research may be negative in these cases, and more detailed examinations may be necessary. LRC is often resistant to conventional therapies. Objective: To describe a case of LRC in which it was necessary to associate the intravenous treatment, intralesional injections and surgical removal of the remaining lesion. Methods: This article is a case report written from medical records of the patient. Main finding: This case required three different treatments to achieve remission, including N-methylglucamine antimoniate intravenous and intralesional, besides a surgery to remove the last parasitic focus. None all cases of LRC require this approach, but some patients are very resistant to conventional treatment. Conclusion: LRC is a rare disease and its treatment can be challenging, since sometimes it is necessary to associate different types of treatments.
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