Abstract
Background : Cutaneous Leishmaniasis (CL) is the most prevalent
clinical form of leishmaniasis and is caused by vector borne protozoan
parasite.1 Variation in diagnostic accuracy exists
between different parasitological and histopathological
examination.2 Test of choice for diagnosis depends not
only on the sensitivity and specificity of a test, but also the
availability, especially in a resource poor setting. CL is difficult for
the clinicians to diagnose because of the rarity of the disease and
non-specific presentation. Here we report a rare case report of CL.
Observation : A 54-year-old female from Gorkha, farmer by
occupation with frequent outdoor activities, presented with lesion over
right thigh for 8 months. Initially single pinhead sized, soft, raised
lesion with brownish red color was noted over right thigh that increased
in size with crust formation. Lesion evolved over period of 2-3 months
and progressed to form ulcer with surrounding redness. On examination,
solitary plaque with crateriform ulcer 3*2 cm in size roughly oval in
shape was present over the right thigh, upper third aspect in the
lateral part, approx.15cm from Anterior Superior Iliac Spine (ASIS).
Ulcer floor was moist, smooth shiny with serous discharge and well
defined raised erythematous margin was present. Biopsy was done which
showed features suggestive of lupus vulgaris, for which Anti Tubercular
Treatment (ATT) was started. There was persistence of ulcer despite 4
months of ATT, for which diagnosis was reconsidered and Fine Needle
Aspiration Cytology (FNAC) was performed. FNAC showed numerous intra and
extracellular amastigotes suggestive of Leishmaniasis which was treated
with complete disappearance of ulcer over 4 months.
Discussion : As CL is rare and given the limitation of available
diagnostic modalities in a resource poor setting, diagnosis can be
confusing. Diagnosis can be made with good clinical acumen and FNAC in
an endemic area.3 With proper diagnosis overall
prevalence of the disease can be estimated and clinical therapeutic
trials can be performed with timely prevention of mucocutaneous
complications.
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