title: Atypical cutaneous leishmaniasis in the immunosuppressed.
abstract: A 45-year-old woman, known case of seronegative arthritis and on immunosuppressive therapy, presented with a 2-week history of a macular lesion on the left calf that became papular and eventually ulcerated. The rest of the history was otherwise unremarkable and systemic examination did not reveal any abnormalities. The lesion was repeatedly biopsied but failed to reveal Leishmania donovani bodies. Concurrent Leishmania IgG was positive but IgM was negative. Leishmania IgG confirmatory testing by ELISA was negative. A biopsy from the lesion eventually tested positive for L. donovani through PCR. The patient was treated with sodium stibogluconate together with intravenous ciprofloxacin and amoxicillin to cover the secondary cutaneous bacterial infection. This led to complete resolution of the lesion.
authors.affiliation: Department of Medicine Foundation Programme, Mater Dei Hospital, Msida, Malta.
authors.forename: Clayton
authors.initials: C
authors.lastname: Micallef
authors.affiliation: Infectious Disease Unit, Mater Dei Hospital, Msida, Malta.
authors.forename: Charles Mallia
authors.initials: CM
authors.lastname: Azzopardi
mesh_terms: D000068879:Adalimumab; D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D000967:Antimony Sodium Gluconate / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001168:Arthritis / Q000188:drug therapy*; D002939:Ciprofloxacin / Q000627:therapeutic use; D060085:Coinfection / Q000188:drug therapy; D016054:DNA, Protozoan / Q000235:genetics*; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007893:Leishmania donovani / Q000235:genetics*; D016773:Leishmaniasis, Cutaneous / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology; D008727:Methotrexate / Q000009:adverse effects*; D008875:Middle Aged
chemical_list: D000900:Anti-Bacterial Agents; D061067:Antibodies, Monoclonal, Humanized; D000981:Antiprotozoal Agents; D016054:DNA, Protozoan; D007166:Immunosuppressive Agents; D002939:Ciprofloxacin; D000658:Amoxicillin; D000068879:Adalimumab; D000967:Antimony Sodium Gluconate; D008727:Methotrexate