title: The first case of isolated facial cutanenous leishmaniasis in a Down syndrome infant: a case report and review of the literature.
abstract: BACKGROUND
  Cutaneous leishmaniasis can be caused by several Leishmania species and is transmitted to human beings and animals by sand flies, Down syndrome is known to cause immunodeficiency that might lead to increase the susceptibility to infection with Leishmania.Up to our knowledge this is the first case of isolated facial cutaneous leshmaniasis in association with Down syndrome.
  
  
  METHODS
  A 2 month old Saudi Arabian male infant was admitted in the pediatric ward of maternity and children's hospital, Buraidah, Kingdom of Saudi Arabia for the management of multiple ulcers on his face, two ulcers were big and were surrounded by edema, causing severe disfigurement. This disfigurement caused difficulty in recognizing the facial feature of Down syndrome. The presence of hypotonia, microcephaly, low set ears, bilateral simian creases and wide separation between big toe and other toes directed us to request karyotyping. The result of karyotyping confirmed the diagnosis of Down syndrome.
  
  
  CONCLUSIONS
  Children with Down syndrome are immunodeficient, they have been reported to have a complex of immunological alterations which might lead to increased susceptibility to infection.
authors.affiliation: Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt. alaaawny@hotmail.com.
authors.forename: Kotb
authors.initials: K
authors.lastname: Abass
authors.forename: Hekma
authors.initials: H
authors.lastname: Saad
authors.forename: Alaa A
authors.initials: AA
authors.lastname: Abd-Elsayed