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ATYPICAL CLINICAL VARIANTS IN NEW WORLD CUTANEOUS LEISHMANIASIS: DISSEMINATED, ERYSIPELOID, AND RECIDIVA CUTIS DUE TO LEISHMANIA (V.) PANAMENSIS

In recent times, there has been an increase in the number of reports for new and rare variants of cutaneous leishmaniasis (CL). Here, we describe three unusual clinical forms of CL identified in Ecuadorian children. A total of 131 patients with CL were diagnosed over a 2-year period of active search. In 3 (2.29%), the lesions were very unusual; these included erysipeloid, recidiva cutis (LRC), and disseminated leishmaniasis (DL). The erysipeloid case is characterized by erythematous and indurated plaque seen on the face of a 5-year-old boy; the LRC one is differentiated by slowly progressing red-brown papules around large scars of healed sores in a 6-year-old girl, and the DL case is characterized by dozens of cutaneous ulcers distributed in the whole body of a 1-year-old girl. Leishmania parasites were isolated by lesion aspirate and analyzed by the technique multilocus enzyme electrophoresis (MLEE). All three isolates were identified as Leishmania (Viannia) panamensis. These distinct clinical variants rarely have been reported previously in the American cutaneous leishmaniasis, and for the first time L. (V.) panamensis was identified as the etiologic agent. Our cases extend the spectrum of clinical presentations in New World leishmaniasis.

Received December 23, 2004. Accepted for publication April 6, 2005.

Acknowledgments: The authors acknowledge Professor Anthony Bryceson for his helpful comments on the manuscript and Hideo Kumazawa for helping with the photographic illustrations.

^* Address correspondence to Manuel Calvopina, Department of Parasitology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan. E-mail: mcalvopina{at}hotmail.com

Authors’ addresses: Manuel Calvopina and Yoshihisa Hashiguchi, Department of Parasitology, Kochi Medical School, Kochi University, Nankoku, Kochi 785-8505, Japan. Hiroshi Uezato and Shigeo Nonaka, Department of Dermatology, Faculty of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan. Eduardo A. Gomez, Departmento de Medicina Tropical, Facultad de Medicina, Universidad Catolica Santiago de Guayaquil, Ecuador. Hirotama Kato, Department of Veterinary Hygiene, Faculty of Agriculture, Yamaguchi University, 1677-1 Yoshida, Yamaguchi 753-8515, Japan.

Reprint requests: Manuel Calvopina, Department of Parasitology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan, Telephone: +81 088 880 2617, Fax: +81 088 880 2415, E-mail: mcalvopina{at}hotmail.com.