Unusual Observations in Leishmaniasis-An Overview

Abstract

Leishmaniasis significantly affects the population of the tropics and subtropics. Clinical features and infective species of Leishmania are the primary factors driving the direction of diagnosis. The rise in incidences of atypical presentations present a challenge in patient treatment. Knowledge of unusual/rare presentations can aid in having a broader perspective for including the different aspects during the examination and thus avoid misdiagnosis. A comprehensive literature survey was performed to present the array of atypical presentations confounding clinicians which have been seen in leishmaniasis. Case reports of unusual findings based on the localizations and morphology of lesions and infective species and the predominant geographical sites over almost five decades highlight such presentations in the population. Information regarding the clinical features recorded in the patient and the chosen treatment was extracted to put forward the preferred drug regimen in such cases. This comprehensive review presents various unusual observations seen in visceral leishmaniasis, post-kala-azar dermal leishmaniasis, cutaneous leishmaniasis, and mucocutaneous leishmaniasis. It highlights the need to consider such features in association with differential diagnosis to facilitate proper treatment of the patient.

Keywords: atypical leishmaniasis; cutaneous leishmaniasis; immunocompromised; leishmaniasis; mucocutaneous leishmaniasis; post-kala-azar dermal leishmaniasis; rare presentations of leishmaniasis; visceral leishmaniasis.

Figure 5

Atypical sites/locations of MCL lesions: (a) focal hard whitish lesions on the true vocal cords of a patient with MCL [202]; (b) lesions on hard and soft palate and cobblestone appearance of lesions on hard palate of MCL patient [213]; (c) lesions on conjunctiva of the upper and lower inner eyelids [221]; (d) multiple granulomatous MCL lesions on the posterior wall of the oropharynx [222]; and (e) lingual leishmaniasis showing swelling on the dorsal part of lingual tissue [224].

Figure 1

Geographical localization of atypical presentations observed in Leishmaniasis. CL: Cutaneous leishmaniasis, PKDL: Post kala-azar dermal leishmaniasis, VL: Visceral leishmaniasis.

Figure 2

Atypical sites/locations of PKDL lesions: (a) unusual involvement of perioral and lingual mucosa [56]; (b) erythematous mucosa with ulcer on retro-commissural area [57]; (c) swelling of lips and muzzle area in patient, (inset: post treatment) [58]; (d) annular lesions on the face of the patient [59]; (e) unusual swelling on forehead in PKDL patient [60]; (f) crusted ulcerative plaques on face and abdomen [61]; (g) crusted erythematous plaque along with loss of vision [62]; (h) severely ulcerated papulo-nodular lesions on face and limbs of patient [49].

Figure 3

Atypical site/location of CL lesions: (a) lip leishmaniasis in patient with red ulcer and crust covering acute swelling on the lower lip [120]; (b) auricular leishmaniasis in patient with indistinct plaque with hyperkeratosis on the antihelix of the ear [122]; (c) ocular leishmaniasis in a patient with several lesions on the face and on right upper eyelid [123].

Figure 4

Atypical morphology of CL lesions: (a) sporotrichoid-type lesions on the upper extremity of the CL patient; (b) lupoid form of lesions observed in arm of the CL patient; (c) psorasiform type of CL lesion on the elbow of the patient’s right arm; (d) eczematoid-type CL lesion on back of the hand; (e) verrucous-type CL lesion on back of the hand; 4 (a–e). [158]; and (f) multiple erythematous lesions with indurated margin and necrotic-purulent base mimicking pyoderma gangrenosum [159].