title: Acute New World cutaneous leishmaniasis presenting as tuberculoid granulomatous dermatitis.
abstract: Acute primary cutaneous leishmaniasis typically presents microscopically with a lymphohistiocytic infiltrate containing admixed plasma cells, parasitized macrophages and abundant organisms. Tuberculoid granulomatous changes may occur in the later phases of primary infection. A 23-year-old male presented 1 month after visiting Peru with classic clinical findings of acute primary cutaneous leishmaniasis, while histopathology showed a tuberculoid granulomatous process that lacked any organisms in hematoxylin-eosin and fungal stains. Polymerase chain reaction (PCR) analysis and tissue cultures confirmed the diagnosis of cutaneous leishmaniasis with Leishmania (Viannia) panamensis infection. A pauci-organism tuberculoid granulomatous process may uncommonly be the presenting histopathology in the acute infectious phase of cutaneous leishmaniasis. Clinicians and dermatopathologists should be aware of this atypical presentation, which may cause diagnostic confusion and delay proper treatment. PCR testing should be employed in cases with high clinical suspicion when histopathology is not definitive.
authors.affiliation: Dermatopathology Section, Department of Dermatology, Boston University School of Medicine, Boston, MA 02118, USA. daniel.miller@bmc.org
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Miller
authors.forename: Barbara A
authors.initials: BA
authors.lastname: Gilchrest
authors.forename: Amit
authors.initials: A
authors.lastname: Garg
authors.forename: Lynne J
authors.initials: LJ
authors.lastname: Goldberg
authors.forename: Jag
authors.initials: J
authors.lastname: Bhawan
mesh_terms: D000328:Adult; D003872:Dermatitis / Q000235:genetics / Q000469:parasitology / Q000473:pathology; D003937:Diagnosis, Differential; D006099:Granuloma / Q000235:genetics / Q000469:parasitology / Q000473:pathology; D006801:Humans; D018334:Leishmania guyanensis / Q000235:genetics*; D007897:Leishmaniasis, Mucocutaneous / Q000235:genetics / Q000469:parasitology / Q000473:pathology; D008297:Male; D010568:Peru; D016133:Polymerase Chain Reaction; D014382:Tuberculosis, Cutaneous / Q000235:genetics / Q000469:parasitology / Q000473:pathology