ABSTRACT
Abstract Background The evaluation of American cutaneous leishmaniasis (CL) and sporotrichosis (SP) with dermoscopy may improve the diagnosis accuracy and clinical monitoring. Objectives To describe the dermoscopic findings and patterns of skin lesions of patients with CL and SP followed up at the Laboratory of Clinical Research and Surveillance in Leishmaniasis (LaPClinVigiLeish), Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. Methods The authors included patients with a diagnosis of CL or SP, who attended at INI/ Fiocruz, between 2019‒2021. All patients had 3 dermoscopic examinations (DermLite DL4): before treatment (T0), during treatment (T1), and after healing (T2). Up to three lesions per patient were evaluated. Results The authors studied 47 patients with CL (74 lesions), and 19 patients with SP (24 lesions). The authors described dermoscopic structures such as rosettes, white lines, white dots, brown focal structureless areas, brown lines and dots, white perilesional circles, perilesional hyperchromic circles, microulcerations and the rainbow patterns. The authors created specific patterns; in CL: CL-T0 "central yellow scales with a white perilesional circle pattern", CL-T1 "diffuse structureless white area pattern" and CL-T2 "white and brown focal structureless areas pattern". In SP: SP-T0 the "pustule with erythema pattern"; SP-T1 the "focal structureless white areas with erythema pattern" and SP-T2 the "white linear pattern". Study limitations This study does not correlate dermoscopic findings with time of disease evolution at the first medical examination. Conclusions The recognition of CL and SP dermoscopy patterns may be helpful tool for the differential diagnosis and monitoring of disease evolution.
ABSTRACT
SUMMARY American tegumentary leishmaniasis (ATL) is an infectious disease caused by protozoa of the genus Leishmania, and transmitted by sandflies. In the state of Rio de Janeiro, almost all of the cases of American tegumentary leishmaniasis (ATL) are caused by Leishmania (Viannia) braziliensis, while cases of visceral leishmaniasis (VL) are caused by Leishmania (Leishmania) infantum chagasi. The resurgence of autochthonous VL cases in Rio de Janeiro is related to the geographic expansion of the vector Lutzomyia longipalpis and its ability to adapt to urban areas. We report the first case of leishmaniasis with exclusively cutaneous manifestations caused by L. (L.) infantum chagasi in an urban area of Rio de Janeiro. An eighty-one-year-old woman presented three pleomorphic skin lesions that were not associated with systemic symptoms or visceromegalies. Multilocus enzyme electrophoresis identified L. (L.) infantum chagasi, but direct smear and PCR of bone narrow were negative for Leishmania sp. (suggesting exclusively cutaneous involvement). We discuss the different dermatological presentations of viscerotropic leishmaniasis of the New and Old World, and the clinical and epidemiological importance of the case. Etiologic diagnosis of ATL based upon exclusive clinical criteria may lead to incorrect conclusions. We should be aware of the constant changes in epidemiological patterns related to leishmaniases.
RESUMO A leishmaniose tegumentar americana (LTA) é uma doença infecciosa causada por protozoários do gênero Leishmania, transmitida por flebotomíneos. No estado do Rio de Janeiro, quase todos os casos de LTA são causados por Leishmania (Viannia) braziliensis, enquanto a leishmaniose visceral (LV) é causada por Leishmania (Leishmania) infantum chagasi. O ressurgimento de casos autóctones de LV no Rio de Janeiro está relacionado com a expansão geográfica dos vetores Lutzomyia longipalpis e à sua capacidade de se adaptar às áreas urbanas. Relatamos o primeiro caso de leishmaniose com manifestações exclusivamente cutâneas causadas por L. (L.) infantum chagasiem uma área urbana do Rio de Janeiro. Mulher de 81 anos apresentou três lesões cutâneas pleomórficas não associadas a sintomas sistêmicos ou visceromegalias. A eletroforese de enzimas multilocus obtida a partir da lesão cutânea identificou L. (L.) infantum chagasi,por outro lado o exame direto e o PCR da medula óssea foram negativos para Leishmaniasp. (sugerindo acometimento exclusivamente cutâneo). Discutimos as diferentes apresentações dermatológicos da leishmaniose visceral do Novo e Velho Mundo, assim como a importância clínica e epidemiológica deste caso. O diagnóstico etiológico da LTA com base apenas em critérios clínicos pode levar a conclusões incorretas. Devemos estar conscientes das constantes mudanças nos padrões epidemiológicos relacionados à leishmaniose.