Erysipeloid Cutaneous Leishmaniasis B55.1

The erysipelas-like form of Old World cutaneous leishmaniasis is a rare variant of cutaneous leishmaniasis. Because the clinical picture is unusual, there is often a delay in diagnosis.

Only to areas of skin that are worn freely.

Erysipelas-like clinical picture with formation of a slowly progressive erythematous , little painful plaque. No fever, no local pain, no regional lymphadenopathy.

Diagnosis is based on direct parasitological examination, detection of Leishmania DNA by PCR, and histological examination.

In Old World cutaneous leishmaniasis, there are a number of morphologic variants:

• acute paronychial leishmaniasis
• chankriform leishmaniasis
• anular leishmaniasis
• palmoplantar leishmaniasis
• zosteriform leishmaniasis
• eczematoid leishmaniasis.

Clinical morphology depends on the immune status of the patient, the Leishmania subspecies, and the site of infection. A diffuse, erysipelas-like form is unusual, and is worthy of attention for differential diagnostic reasons alone, in contrast to erysipelas.

The 63-year-old traveler to Iran (stay 1 month before onset of illness) presented because of a slowly enlarging red plaque on the left cheek that had been present for 5 months. Various antibiotic pretreatments were without effect. Clinical examination revealed a rich red, little painful, surface-smooth, moderately consistent enlarged plaque. No fever, no regional lymphadenopathy, no CRP elevation. The diagnosis of cutaneous leishmaniasis was made bioptically. Intramuscular treatment with meglumine antimonate at a dose of 20 mg/kg per day was administered.

1. Parajuli N et al (2020) Case Report: Erysipeloid Cutaneous Leishmaniasis Treated with Oral Miltefosine. Am J Trop Med Hyg 104:643-645.
2. El kartouti A et al (2015) Leishmaniose cutanée érysipéloide: à propos d'une observation clinique. Pan Afr Med J 21:54.