title: [Disseminated cutaneous leishmaniasis secondary to lymphoedema: two cases].
abstract: BACKGROUND
  Dissemination of cutaneous leishmaniasis may take various forms: satellite papules, sporotrichoid nodules and widespread papulonodular lesions (disseminated cutaneous leishmaniasis). We describe a particular clinical form of dissemination in two patients with erysipelas secondary to lymphoedema.
  
  
  METHODS
  Case 1. A 75-year-old man with diabetes consulted for erysipelas of the leg secondary to lymphoedema. The site of entry was an infected cutaneous leishmaniasis lesion. The initial outcome was favourable under intravenous penicillin G treatment. Twelve days later, some fifty papulonodular lesions appeared and were strictly limited to the erythematous erysipelas plaque. PCR screening of papulonodular lesion smears for Leishman bodies was positive. Histological examination of skin biopsy samples showed lobular panniculitis. Case 2. A 64-year-old woman with diabetes presented erysipelas in the right upper limb secondary to lymphoedema scattered with multiple erythematous, infiltrated, papular lesions in a setting of cutaneous leishmaniasis lesions. PCR analysis of smears taken from the secondary nodular lesions demonstrated the presence of leishmaniasis, while histological analysis of biopsy samples revealed panniculitis.
  
  
  CONCLUSIONS
  Disseminated cutaneous leishmaniasis is characterized by the appearance of multiple (>10) pleomorphic lesions on two or more noncontiguous areas of the body. Our two patients presented certain features of disseminated cutaneous leishmaniasis. However, they were unusual in terms of the strict localisation of nodular lesions to the erysipelas plaque. This particular aspect suggests haemolymphatic dissemination of the protozoan infection from the initial lesion as a result of local factors.
authors.affiliation: Service de dermatologie, EPS Hédi Chaker, Sfax 3029, Tunisia.
authors.forename: T J
authors.initials: TJ
authors.lastname: Meziou
authors.forename: H
authors.initials: H
authors.lastname: Chaabène
authors.forename: A
authors.initials: A
authors.lastname: Masmoudi
authors.forename: S
authors.initials: S
authors.lastname: Boudaya
authors.forename: H
authors.initials: H
authors.lastname: Cheikhrouhou
authors.forename: S
authors.initials: S
authors.lastname: Bouassida
authors.forename: H
authors.initials: H
authors.lastname: Turki
mesh_terms: D000368:Aged; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D048909:Diabetes Complications; D004886:Erysipelas / Q000150:complications; D005260:Female; D006801:Humans; D016774:Leishmaniasis, Diffuse Cutaneous / Q000209:etiology*; D035002:Lower Extremity / Q000469:parasitology; D008209:Lymphedema / Q000469:parasitology*; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D034941:Upper Extremity / Q000469:parasitology
chemical_list: D000981:Antiprotozoal Agents; D008795:Metronidazole