South American cutaneous leishmaniasis of the eyelids: report of five cases in Rio de Janeiro State, Brazil.
OBJECTIVE
To describe American cutaneous leishmaniasis of the eyelids and highlight the main clinical and diagnostic features of lesions, which are rare in this location.


METHODS
Retrospective, noncomparative case series


METHODS
Leishmanin skin test, touch preparations, histopathologic analysis, and culture in appropriate media were used for clinical confirmation and parasitologic diagnosis. Positive cultures were identified by the iso-enzymes technique. All patients were treated with pentavalent antimony applied intramuscularly.


RESULTS
Leishmanin skin test was positive in all five patients. Touch preparations, histopathologic analysis, and culture were performed in four patients. Touch preparations were positive (presence of Leishman's bodies) in two patients; histopathologic analysis showed a granulomatous infiltrate in four patients and parasite was present in two patients; culture was positive in three patients, and in two the parasite was identified as Leishmania (Viannia) braziliensis. Therapy was effective for all patients.


CONCLUSIONS
Cutaneous leishmaniasis of the eyelids is uncommon in the Americas. The disease may present diagnostic difficulties when appearing in nonendemic areas. The clues for diagnosis are the clinical aspect of lesions, the epidemiologic data, and a positive Leishmanin skin test. Demonstration of parasite is not always possible. Pentavalent antimonial compounds are the therapy of choice. Formerly, transmission of leishmaniasis occurred only when humans penetrated forested areas and became an incidental host. Now, eyelid lesions are part of the changing pattern in the transmission of the disease. With the increase in ecotourism, these lesions may begin to be seen in air travelers returning to other parts of the world.
Oliveira-Neto
M P
MP
Department of Ophthalmology, Evandro Chagas Hospital, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Martins
V J
VJ
Mattos
M S
MS
Pirmez
C
C
Brahin
L R
LR
Benchimol
E
E
D000368:Aged; D000818:Animals; D000965:Antimony / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D002712:Chlorides / Q000627:therapeutic use; D015822:Eye Infections, Parasitic / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology; D005141:Eyelid Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology; D005143:Eyelids / Q000469:parasitology / Q000473:pathology*; D005260:Female; D006801:Humans; D007892:Leishmania braziliensis / Q000302:isolation & purification*; D016773:Leishmaniasis, Cutaneous / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology; D008297:Male; D012189:Retrospective Studies
D000981:Antiprotozoal Agents; D002712:Chlorides; C047841:antimony pentachloride; D000965:Antimony