New World Leishmaniasis: The Role of Confocal Microscopy in Diagnosis and Follow-up - Tropical Dermatology

  • Ana Ortins-Pina Centro Hospitalar Lisboa Norte EPE, Hospital de Santa Maria, Serviço de Dermatologia. Lisboa, Portugal http://orcid.org/0000-0003-3599-9881
  • Luís Soares-de-Almeida Centro Hospitalar Lisboa Norte EPE, Hospital de Santa Maria, Serviço de Dermatologia. Lisboa, Portugal; Universidade de Lisboa, Faculdade de Medicina, Clínica Universitária de Dermatologia de Lisboa. Lisboa, Portugal; Instituto de Medicina Molecular. Lisboa, Portugal
  • Paulo Filipe Centro Hospitalar Lisboa Norte EPE, Hospital de Santa Maria, Serviço de Dermatologia. Lisboa, Portugal; Universidade de Lisboa, Faculdade de Medicina, Clínica Universitária de Dermatologia de Lisboa. Lisboa, Portugal; Instituto de Medicina Molecular. Lisboa, Portugal
  • André Laureano Oliveira Universidade de Lisboa, Faculdade de Medicina, Clínica Universitária de Dermatologia de Lisboa. Lisboa, Portugal
Keywords: Dermoscopy, Leishmania, Leishmaniasis, Cutaneous/diagnosis, Microscopy, Confocal

Abstract

Cutaneous leishmaniasis may mimic other infections in overlapping endemic areas and timely treatment prevents dissemination of the parasite. The required histopathological and microbiological examinations are not always available, and can only give a deferred confirmation of the diagnosis. In contrast, reflectance confocal microscopy (RCM) allows real-time visualization till the level of papillary dermis. A 59-year-old Brazilian male presented with ulcerated plaques and tumors on the extremities. The clinical differential diagnosis included leishmaniasis and other infections with lymphocutaneous pattern of dissemination. RCM showed the characteristic picture of «eggs in a bird’s nest» which has been described in cutaneous leishmaniasis. The diagnosis of leishmaniasis was later confirmed by skin biopsy, in which Leishmania guyanensis was identified by parasitological examination. After treatment with liposomal amphotericin B, reassessment with RCM corroborated the clinical cure, showing an «empty nest» picture. In conclusion, RCM noninvasively provides useful information for diagnosis and follow-up of cutaneous leishmaniasis.

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Published
2018-12-27
How to Cite
Ortins-Pina, A., Soares-de-Almeida, L., Filipe, P., & Oliveira, A. L. (2018). New World Leishmaniasis: The Role of Confocal Microscopy in Diagnosis and Follow-up - Tropical Dermatology. Journal of the Portuguese Society of Dermatology and Venereology, 76(4), 445-450. https://doi.org/10.29021/spdv.76.4.972
Section
Case Reports

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