Comorbidity of leishmania major with cutaneous sarcoidosis

Abstract

Background: leishmaniasis infection might manifest as sarcoidosis; on the other hand, some evidences propose an association between sarcoidosis and leishmaniasis. Most of the times, it is impossible to discriminate idiopathic sarcoidosis from leishmaniasis by conventional histopathologic exam.

Aim: We performed a cross-sectional study to examine the association of sarcoidosis with leishmaniasis in histopathologically diagnosed sarcoidal granuloma biopsy samples by polymerase chain reaction (PCR).

Materials and methods: We examined paraffin-embedded skin biopsy samples obtained from patients with clinical and histopathological diagnosis as naked sarcoidal granuloma, referred to Skin Research Center of Shaheed Beheshti Medical University from January 2001 to March 2010, in order to isolate Leishmania parasite. The samples were reassessed by an independent dermatopathologist. DNA extracted from all specimens was analyzed by the commercially available PCR kits (DNPTM Kit, CinnaGen, Tehran, Iran) to detect endemic Leishmania species, namely leishmania major (L. major).

Results: L. major was positive in PCR of Eight out of twenty-five examined samples.

Conclusion: Cutaneous leishmaniasis may be misinterpreted as sarcoidosis; in endemic areas, when conventional methods fail to detect Leishmania parasite, PCR should be utilized in any granulomatous skin disease compatible with sarcoidosis, regardless of the clinical presentation or histopathological interpretation.

Keywords: Cutaneous leishmaniasis; Leishmania major; polymerase chain reaction; sarcoidal type granuloma; sarcoidosis.

Figure 1

An asteroid body is shown within a multinucleated giant cell (Black arrow) (H and E, ×40)

Figure 2

Agarose gel electrophoresis of PCR products from paraffin embedded samples. (a) 100 DNA ladder. Neg: Negative control A (No DNA template on the PCR reaction). Column #1. PCR amplification of the paraffin embedded from patient number 4; Column # 2. PCR amplification of the paraffin embedded from patient number 8; Column # 3. PCR amplification of the paraffin embedded from patient number 19; Pos: PCR amplification of the L. major standard strain. (b) 100 DNA ladder. Neg: Negative control A (No DNA template on the PCR reaction). Column # 4. PCR amplification of the paraffin embedded from patient number 14; Column # 5. PCR amplification of the paraffin embedded from patient number 18. Column # 6. PCR amplification of the paraffin embedded from patient number 20. (c) 100 DNA ladder. Neg: Negative control A (No DNA template on the PCR reaction). Column # 7. PCR amplification of the paraffin embedded BAL sample from patient number 13. Column # 8. PCR amplification of the paraffin embedded skin sample from patient number 13