Localized cutaneous nodule in an older patient.

Area of Science:

• Dermatology
• Infectious Diseases
• Pathology

Background:

• Localized cutaneous nodules are common in the elderly, presenting a diagnostic challenge as they can indicate benign or malignant conditions.
• Cutaneous leishmaniasis (CL), particularly L. donovani, is rare in Europe and can mimic malignancy, complicating diagnosis in older adults.
• A patient with renal comorbidities and a history of cancer presented with nodules that mimicked malignancy.

Purpose of the Study:

• To highlight the diagnostic challenges posed by cutaneous leishmaniasis (CL) in an elderly patient.
• To emphasize the importance of considering CL in the differential diagnosis of chronic nodules, even with minimal travel history.
• To illustrate the role of histopathology and staining in confirming CL and guiding individualized treatment strategies.

Main Methods:

• Histopathology and staining were used to confirm the diagnosis of cutaneous leishmaniasis (CL).
• Clinical presentation and patient history, including comorbidities and prior cancer, were considered for treatment planning.
• Differential diagnosis was established by comparing clinical features with known causes of cutaneous nodules.

Main Results:

• Cutaneous leishmaniasis (CL) due to L. donovani was diagnosed in an elderly woman, mimicking malignancy.
• The diagnosis was confirmed through histopathology and staining.
• Local treatment was chosen over systemic therapy due to the patient's renal comorbidities and history of cancer.

Conclusions:

• Cutaneous leishmaniasis (CL) should be considered in the differential diagnosis of chronic nodules in the elderly, especially those with a history of travel to endemic areas.
• Biopsy is essential for accurate diagnosis of CL and for developing appropriate, individualized management plans.
• Prompt diagnosis and tailored treatment are crucial for managing CL, particularly in elderly patients with complex medical histories.