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Caseous necrosis in cutaneous leishmaniasis

E Peltier1, P Wolkenstein, M Deniau

  • 1Service d'Anatomie et de Cytologie Pathologiques, Hôpital Antoine Béclère, Clamart, France.

Journal of Clinical Pathology
|June 1, 1996
PubMed
Summary
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This case report details late-stage cutaneous leishmaniasis presenting with focal caseous necrosis. The unusual histology, lacking visible parasites, highlights potential diagnostic challenges mimicking other granulomatous diseases.

Area of Science:

  • Dermatology
  • Infectious Diseases
  • Pathology

Background:

  • Cutaneous leishmaniasis is a parasitic infection with diverse clinical and histological presentations.
  • Late-stage disease can exhibit atypical features, complicating diagnosis.
  • Idiopathic bone marrow aplasia was a co-morbidity in this patient.

Observation:

  • Microscopic examination revealed epidermal changes (hyperkeratosis, acanthosis) and dermal epithelioid granulomas.
  • A key finding was focal acidophilic, granular necrosis within tuberculoid lesions, and fibrinoid necrosis in the upper dermis.
  • Inflammatory infiltrate included histiocytes, lymphocytes, and plasma cells; Leishman-Donovan bodies were absent.

Findings:

  • Leishmaniasis was confirmed via culture of skin biopsy specimens, despite the absence of identifiable parasites histologically.

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  • The presence of focal caseous necrosis is a peculiar histological feature in this case.
  • No acid-fast mycobacteria were detected.

    • Implications:

    • The histological finding of caseous necrosis can lead to misdiagnosis of other granulomatous conditions like tuberculosis, syphilis, acne agminata, or sarcoidosis.
    • This case underscores the importance of considering leishmaniasis in differential diagnoses, especially when parasites are not readily apparent.
    • Diagnostic confirmation relies on microbiological culture when histological features are ambiguous.