Coinfection of Leprosy and American Cutaneous Leishmaniasis: A Case Report From Ceará, Brazil

Leprosy and American cutaneous leishmaniasis are endemic diseases in Brazil that may coexist in the same host, particularly in coendemic regions. We report the case of a 68-year-old woman presenting with a six-month history of an ulcerated lesion on the left knee and concomitant disseminated annular plaques associated with sensory loss, madarosis, and peripheral nerve thickening. Histopathological examination of the ulcer demonstrated findings compatible with cutaneous leishmaniasis; immunohistochemistry using CD1a highlighted structures compatible with amastigotes, acknowledging its limitations. Biopsy of the plaques revealed a chronic granulomatous dermatitis with numerous acid-fast bacilli, corroborating multibacillary leprosy in the appropriate clinical context. The patient was treated with multidrug therapy for leprosy and intralesional meglumine antimoniate for leishmaniasis, with favorable outcomes. To the best of our knowledge, this is the first published report of such coinfection in Ceará. This case highlights the importance of sampling lesions with distinct morphologies and integrating clinical, histopathological, and laboratory findings in endemic settings.