[Unusual clinical presentation of cutaneous leishmaniasis in three diabetic patients]

Cutaneous leishmaniasis (CL) is a parasitic infection characterized by significant clinical variability. Unusual and atypical clinical aspects of infection have been reported in immunodeficient patients or associated with particular parasite species. We report three cases of CL from foci of Leishmania major with a particular clinical presentation in diabetic patients.

Patient 1: a 37-year-old man was admitted to the dermatology department for cutaneous vegetative ulcers spreading to the dorsal surface of the foot. History-taking revealed a stay in Er-Rachidia (East of Morocco, a known focus of CL L. major) six weeks earlier. Diabetes mellitus type I was discovered during hospitalization. The patient's 43-year-old sister (patient 2), diabetic for 6 years, consulted for a single leg ulcer appearing 3 months after the same trip to Er-Rachidia. Patient 3: a 61-year-old patient with a 7-year history of diabetes and under oral antidiabetics presented an extended vegetative lesion of the posterior surface of the leg 2 months after staying in Er-Rachidia. A diagnosis of CL was retained on the basis of epidemiology and history (living in an endemic areas of leishmaniasis), coupled in patients 1 and 3 with microbiological evidence involving identification of Leishmania bodies in skin smears or skin biopsies. All patients were treated with two intra-lesional injections per week of meglumine antimony (Glucantime(®)) for 6 weeks. The outcome was marked in all cases by healing of lesions and persistent pigmented scarring.

We described three particular clinical aspect of CL emerging from a known focus of L. major, where infection is classically associated with vegetative or ulcero-vegetative lesions. This unusual profile suggests the role of factors related to parasite species and/or diabetes found in our three patients.