A Presumptive Case of Mucocutaneous and Visceral Leishmaniasis in Nonendemic Country

Leishmaniasis is a complex disease caused by Leishmania parasites and transmitted through the bite of infected sandflies, that is classified into cutaneous leishmaniasis (CL), mucocutaneous leishmaniasis (MCL), and visceral leishmaniasis (VL). The increase in international travel has resulted in cases of leishmaniasis emerging in nonendemic regions, often creating challenges in diagnosis. We report a case of presumptive MCL and VL in a 20-year-old female who complained of multiple skin rashes on the face and body, accompanied by erosions on the lips and eyes. A physical examination showed erosions on the eyes, lips, vulva, and "volcanic" noduloulcerative skin lesions covered with adherent crusts on the face, neck, upper and lower extremities. A biopsy of the skin lesion revealed structures resembling Leishman-Donovan bodies, then the diagnosis of MCL was established. The patient was given 200 mg/day of itraconazole. On the 12th day of itraconazole treatment, the patient experienced shortness of breath and was hospitalized in the Internal Medicine Department. The laboratory examination showed anemia, thrombocytosis, elevated C-reactive protein, and elevated erythrocyte sedimentation rate levels. Computed tomography of the thorax revealed ground-glass opacity, suggestive of lung inflammation. Bone marrow aspiration showed features of hemophagocytic lymphohistiocytosis, and abdominal ultrasound revealed hepatomegaly. The patient was subsequently diagnosed with VL and was treated with amphotericin B. Unfortunately, the patient died due to respiratory failure. Diagnosing leishmaniasis in nonendemic countries is challenging due to the lack of diagnostic tools to identify the protozoa. Dermatologists must recognize clinical signs, be familiar with supportive examinations, and proficiently treat suspected leishmaniasis.