Unusual location of cutaneous leishmaniasis on the hallux in a Brazilian patient

Unusual location of cutaneous leishmaniasis on the hallux in a Brazilian patient

Author Ogawa, M. M. Google Scholar
Macedo, F. S. Google Scholar
Alchorne, MMA Google Scholar
Tomimori-Yamashita, J. Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract A 70-year-old white Brazilian woman from a rural area had a 2-year history of a painful lesion on her left toe. the lesion increased progressively in size followed by toenail destruction. She was treated with systemic antibiotics for secondary bacterial infection several times without any clinical response.Physical examination showed an erythematous swelling on the first toe with an irregular 2.5 cm ulcer with a raised edge that was infiltrating and destroying the toenail. the bottom of the ulcer was granular and partially covered with a crust (Fig. 1).Laboratory studies showed a strong positive Montenegro intradermal reaction (2.5 mm). Other intradermal reactions were also performed, such as purified protein derivative (PPD) and sporotrichin, which were negative. On X-ray examination of the left foot, bone destruction of the distal phalanx of the first toe and a soft tissue swelling were observed (Fig. 2).A biopsy was taken and the histologic picture showed a chronic inflammatory change with tuberculoid-type granuloma and necrosis suggesting leishmaniasis, although parasites were not observed.Based on the clinical, histologic, and immunologic aspects, we concluded that this was a case of leishmaniasis. Methylglucamine (Glucantime(R)) was introduced at a total dose of 17 g of the salt (10 mg/kg daily for 40 days). Immediately after the start of treatment, the lesion began to improve, and 4 months later the lesion had healed completely and the dystrophic nail had started to grow (Fig. 3).
Language English
Date 2002-07-01
Published in International Journal of Dermatology. Oxford: Blackwell Publishing Ltd, v. 41, n. 7, p. 439-440, 2002.
ISSN 0011-9059 (Sherpa/Romeo, impact factor)
Publisher Blackwell Publishing Ltd
Extent 439-440
Origin http://dx.doi.org/10.1046/j.1365-4362.2002.01521.x
Access rights Closed access
Type Article
Web of Science ID WOS:000176799700018
URI http://repositorio.unifesp.br/handle/11600/26916

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