Valdir Sabbaga AmatoI; Adriana Coracini TonacioII; Manoella do Monte AlvesII
IDivision of Infectious and Parasitic Diseases at the Hospital of Clinics, School of Medicine, University of São Paulo, São Paulo, SP, Brazil IIDepartment of Infectious and Parasitic Diseases, Hospital of Clinics, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
A 52-year-old woman was referred to our service because of a painful skin lesion that had been progressing for five months. Initially, it was just an insect bite, but it evolved into an ulcer on her left leg (Figure A). The ulcer was necrotic and exudative, with a granulated base, and its diameter was 10 centimeters. Tissue scraping was performed, and the presence of amastigotes of Leishmania sp was confirmed by examination under a microscope and by immunohistochemical methods. Antimicrobial therapy for secondary infection, in association with 2.4g of intravenous liposomal amphotericin B (total dose: 40mg/kg of body weight), was prescribed. Figure B shows the evolution of the cutaneous lesion at the end of the treatment. A plastic surgery procedure was performed to cover the remaining ulcer (Figure C). This kind of cutaneous leishmaniasis was atypical, because its size was larger than what is usually described. Certain factors may have contributed towards this evolution, such as diabetes and secondary infection.
REFERENCES
1. Ministério da Saude, Secretaria de Vigilância em Saude. Manual de Vigilancia da Leishmaniose Tegumentar Americana. 2ª. Edição, Brasilia. Editora do Ministério da Saude; 2007. [ Links ]
2. Sampaio RN, Marsden PD. Treatment of the mucosal form of leishmaniasis without response to glucantime, with liposomal amphotericin B. Rev Soc Bras Med Trop 1997; 30:125-128. [ Links ]
3. Lambertucci JR, Silva LC. Mucocutaneous leishmaniasis treated with liposomal amphotericin B. Rev Soc Bras Med Trop 2008; 41:87-88. [ Links ]
Address to:
Dr. Valdir Sabbaga Amato
Divisão de Moléstias Infecciosas e Parasitárias/DMIP/HC/FMUSP
Av. Dr. Enéas de Carvalho Aguiar 255/4º andar, Cerqueira César
05403-000 São Paulo, SP, Brasil
Phone: 55 11 3069-6530
e-mail: valdirsa@netpoint.com.br
Received in 10/12/2009
Accepted in 04/02/2010
