Sporotrichoid leishmaniasis in patients from Saudi Arabia: clinical and histologic features.

The clinical and pathologic presentations of cutaneous leishmaniasis in the various countries of the Middle East are well documented. The defined patterns currently encountered in the region emphasize the rarity of local extension of the infection from the bite site. Between 1970 and 1980 we have seen 24 patients with cutaneous leishmaniasis who acquired the infection in Saudi Arabia. In these patients there were several interesting variations from the hitherto described patterns of Oriental sore. The variations include, clinically, the appearance of satellite lesions and the presence of sporotrichoid spread of infection; and histologically, the presence of stellate intradermal abscesses. Such variations in the clinical and pathologic presentations may be due to differences either in the host's immunologic reactivity or in the Leishmania organisms found in Saudi Arabia. Speculative evidence supports the possibility of a different strain and/or species of Leishmania tropica in Saudi Arabia, which in turn may be responsible for this unique clinicopathologic presentation.

Right hemothorax: an unusual presentation of ruptured infrarenal abdominal aortic aneurysm.

The authors describe what they believe is the first reported case of rupture of an infrarenal abdominal aortic aneurysm into the right pleural cavity. A 75-year-old woman presented simultaneously with two common causes of severe abdominal pain and hypotension: perforated duodenal ulcer and ruptured abdominal aortic aneurysm. The absence of an infrarenal retroperitoneal hematoma delayed the diagnosis of rupture of the abdominal aortic aneurysm and the terminal event was exsanguination into the right pleural cavity through an erosion in the right hemidiaphragm.