[Lymphadenopathies in American cutaneous leishmaniasis: comments on 2 cases]

Two patients, with cervical lymphadenopathies and a presumptive diagnosis of lymphoma or scrofula, were submitted to biopsies of the affected lymph nodes. Unexpectedly, the histological picture revealed a necrotic-granulomatous reaction and the presence of leishmania (amastigotes) in some vacuolated macrophages. The patients were from different endemic areas of leishmaniasis in Brazil, and had no perceptible cutaneous or mucosal lesions. Later, however, one of them developed such lesions, probably as an effect of a treatment for toxoplasmosis. These findings support the idea that the agents of the disease, once in the host organism, would invade the organs of the phagocytic-mononuclear system, there remaining for a long time, maybe for the rest of the host life. Eventually, under the action of several factors, that could modify the host resistance, the parasites migrate to the skin or the mucosal membranes, causing secondary or reactivating lesions.