Visual Diagnosis in Emergency Medicine| Volume 54, ISSUE 5, P692-693, May 2018

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American Tegumentary Leishmaniasis

  • Fred Bernardes Filho
    Reprint Address: Fred Bernardes Filho, md, Dermatology Division, Department of Medical Clinics, Ribeirao Preto Medical School, University of São Paulo. Av. Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, São Paulo, Brazil
    Emergency Department, Hospital Imaculada Conceição da Sociedade Portuguesa de Beneficência, Ribeirão Preto, São Paulo, Brazil

    Dermatology Division, Department of Medical Clinics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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  • Rodolfo Mendes Queiroz
    Department of Radiology and Imaging, Santa Casa da Misericórdia of Avaré, Avaré, São Paulo, Brazil

    CENTROMED Diagnóstico por Imagem, Avaré, São Paulo, Brazil
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  • Breno Nery
    Department of Neurosurgery, Hospital Imaculada Conceição da Sociedade Portuguesa de Beneficência, Ribeirão Preto, São Paulo, Brazil
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      A 49-year-old male patient, alcoholic, smoker, and cocaine user presented with a 3-month history of mucocutaneous ulcers. He was facing psychological, social, and behavioral consequences brought about by the lesions' repulsive features. Positive findings on physical examination included two skin ulcers with raised indurated border, an ulcerovegetative lesion on the lower lip, and an erythematous ill-defined plaque on the fifth left finger with onycholysis (Figure 1). Histopathology showed dense inflammatory infiltrate consisting of plasma cells, lymphocytes, and macrophages, presenting formation of epithelioid cell granulomas with frequent multinucleated giant cells. Polymerase chain reaction was positive for Leishmania spp (Figure 2). The patient was treated with meglumine antimoniate, 20 mg/Kg/day for 30 days. He responded well to treatment, with no reactivation during follow-up.
      Figure thumbnail gr1
      Figure 1Painless circular ulcers with infiltrated frame-like borders on right forearm and left pectoral region, ellipticalerosion located on the mid-lower lip, and ulcerative chronic paronychia like lesion on the fifth left finger.
      Figure thumbnail gr2
      Figure 2Polymerase chain reaction (PCR) Leishmania result. 2% Agarose gel, with PCR product with sp1/sp2 primers, specific for Leishmania. 120pb positive fragment. (1) Patient sample; (2) Positive control (L. braziliensis culture); (3) Negative control; (4) DNA Ladder (100 bp).
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