title: Cutaneous Leishmaniasis: An Overlooked Etiology of Midfacial Destructive Lesions.
abstract: BACKGROUND
  Midline destructive lesions of the face (MDL) have a wide range of etiologies. Cutaneous Leishmaniasis (CL) is rarely reported as a possible cause.
  
  
  METHODS
  Fifteen patients with solitary nasal lesions caused by CL were studied. The clinical data, biopsies/scrapings and PCR were collected/performed. Ridley's Pattern (RP) and Parasitic Index (PI) were documented.
  
  
  RESULTS
  Patients' age ranged from 1 to 60 years including 7 males and 8 females. The duration of the observed lesions ranged from 1 to 18 months. Clinically, the lesions showed 6 patterns varying from dermal erythematous papulonodular with no epidermal changes to destructive erythematous plaque with massive central hemorrhagic crust. The clinical impression ranged from neoplastic to inflammatory processes. RP varied among the cases [RP 3 (n = 6), RP 4 (n = 3), RP 5 (n = 6)]. All cases show low PI [PI 0 (n = 7), PI 1 (n = 6), PI 2 (n = 1), and PI 3 (n = 1)]. Higher PI was noted in the pediatric group [average age 24 years for PI 0-1 vs. 6.5 years for PI 2-3]. Molecular speciation showed Leishmania tropica (n = 13) and Leishmania major (n = 2). All the patients received Meglumine Antimoniate (Glucantine) injections and had initial cure defined as complete scarring and disappearance of inflammatory signs within 3 months.
  
  
  CONCLUSIONS
  Leishmaniasis may cause MDL especially in endemic areas. PCR is instrumental in confirming the diagnosis. MDL caused by CL showed wide spectrum of clinical and microscopic presentation.
authors: American University of Beirut Medical Center, Department of Otolaryngology Head and Neck Surgery, Beirut, Lebanon.
authors: Elie
authors: E
authors: Alam
authors: American University of Beirut Medical Center, Department of Dermatology, Beirut, Lebanon.
authors: Ossama
authors: O
authors: Abbas
authors: American University of Beirut Medical Center, Department of Otolaryngology Head and Neck Surgery, Beirut, Lebanon.
authors: Roger
authors: R
authors: Moukarbel
authors: American University of Beirut Medical Center, Department of Pathology and Laboratory Medicine, Beirut, Lebanon.
authors: Ibrahim
authors: I
authors: Khalifeh
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016773:Leishmaniasis, Cutaneous / Q000150:complications*; D008297:Male; D008536:Meglumine / Q000008:administration & dosage; D000077485:Meglumine Antimoniate; D008875:Middle Aged; D009666:Nose / Q000002:abnormalities*; D009668:Nose Diseases / Q000188:drug therapy* / Q000209:etiology; D009942:Organometallic Compounds / Q000008:administration & dosage; D016133:Polymerase Chain Reaction; D055815:Young Adult
chemical_list: D009942:Organometallic Compounds; D008536:Meglumine; D000077485:Meglumine Antimoniate