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    Erosive hemorraghic infiltrated plaques on the left shin, suspective for cutaneous leishmaniasis.

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    Target lesions (arrows) on the palm of the left hand.

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    Hematoxylin and eosin (H&E) stain showing dermatitis in the upper dermis and spongiosis at the dermal-epidermal junction (A) ×40. Vacuolization of epidermal basal cells (B) ×400, and the presence of necrotic keratinocytes (C) ×1,000.

  • 1.

    Reed SG, Badaró R, Masur H, Carvalho EM, Lorenco R, Lisboa A, Teixeira R, Johnson WD Jr, Jones TC, 1986. Selection of a skin test antigen for American visceral leishmaniasis. Am J Trop Med Hyg 35: 7985.

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    • Export Citation
  • 2.

    Machado P, Araújo C, Da Silva AT, Almeida RP, D'Oliveira A Jr, Bittencourt A, Carvalho EM, 2002. Failure of early treatment of cutaneous leishmaniasis in preventing the development of an ulcer. Clin Infect Dis 34: E69E73.

    • Search Google Scholar
    • Export Citation
  • 3.

    Machado PR, Carvalho AM, Machado GU, Dantas ML, Arruda S, 2011. Development of cutaneous leishmaniasis after Leishmania skin test. Case Rep Med 2011: 631079.

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    • Export Citation
 
 
 

 

 
 
 

 

 

 

 

 

 

Erythema Exsudativum Multiforme after a Leishmania Skin Test

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  • Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Rua João das Botas S/N, Canela, Salvador; Universidade Federal da Bahia, Salvador, Bahia, Brazil

A 45-year-old otherwise healthy male from an endemic region for Leishmania braziliensis infection in Bahia, Brazil, presented with three erosive hemorrhagic infiltrated plaques on the left shin accompanied with lymphadenopathy in the groin since one month (). A Leishmania skin test performed on the left forearm was strongly positive (20 × 18 mm). Two days later, the patient felt sick and feverish. Painful erythematous target lesions developed on the palms and scapula together with conjunctivitis (). Histopathology confirmed erythema exsudativum multiforme (EEM) (). Both EEM and cutaneous leishmaniasis were successfully treated with a 5-day course of prednisone 20 mg, and a 20-day course of intravenous pentavalent antimony, respectively.

A 45-year-old otherwise healthy male from an endemic region for Leishmania braziliensis infection in Bahia, Brazil, presented with three erosive hemorrhagic infiltrated plaques on the left shin accompanied with lymphadenopathy in the groin since one month (Figure 1). A Leishmania skin test performed on the left forearm was strongly positive (20 × 18 mm).1 Two days later, the patient felt sick and feverish. Painful erythematous target lesions developed on the palms and scapula together with conjunctivitis (Figure 2). Histopathology confirmed erythema exsudativum multiforme (EEM) (Figure 3). Both EEM and cutaneous leishmaniasis were successfully treated with a 5-day course of prednisone 20 mg, and a 20-day course of intravenous pentavalent antimony, respectively.

Figure 1.
Figure 1.

Erosive hemorraghic infiltrated plaques on the left shin, suspective for cutaneous leishmaniasis.

Citation: The American Society of Tropical Medicine and Hygiene 90, 4; 10.4269/ajtmh.13-0166

Figure 2.
Figure 2.

Target lesions (arrows) on the palm of the left hand.

Citation: The American Society of Tropical Medicine and Hygiene 90, 4; 10.4269/ajtmh.13-0166

Figure 3.
Figure 3.

Hematoxylin and eosin (H&E) stain showing dermatitis in the upper dermis and spongiosis at the dermal-epidermal junction (A) ×40. Vacuolization of epidermal basal cells (B) ×400, and the presence of necrotic keratinocytes (C) ×1,000.

Citation: The American Society of Tropical Medicine and Hygiene 90, 4; 10.4269/ajtmh.13-0166

This case supports the hypothesis that an exacerbated host immune response against Leishmania antigens may be associated with tissue damage and several clinical manifestations including EEM2,3; this case should alert the clinicians that Leishmania skin test is not totally risk free and may trigger hypersensitivity reactions.

ACKNOWLEDGMENTS

We acknowledge Dr. Sérgio Arruda for the histopathology.

  • 1.

    Reed SG, Badaró R, Masur H, Carvalho EM, Lorenco R, Lisboa A, Teixeira R, Johnson WD Jr, Jones TC, 1986. Selection of a skin test antigen for American visceral leishmaniasis. Am J Trop Med Hyg 35: 7985.

    • Search Google Scholar
    • Export Citation
  • 2.

    Machado P, Araújo C, Da Silva AT, Almeida RP, D'Oliveira A Jr, Bittencourt A, Carvalho EM, 2002. Failure of early treatment of cutaneous leishmaniasis in preventing the development of an ulcer. Clin Infect Dis 34: E69E73.

    • Search Google Scholar
    • Export Citation
  • 3.

    Machado PR, Carvalho AM, Machado GU, Dantas ML, Arruda S, 2011. Development of cutaneous leishmaniasis after Leishmania skin test. Case Rep Med 2011: 631079.

    • Search Google Scholar
    • Export Citation

Author Notes

* Address correspondence to Bas S. Wind, Department of Dermatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail: b.s.wind@amc.uva.nl

Authors' addresses: Bas S. Wind, Department of Dermatology, Academic Medical Center, Amsterdam, The Netherlands, E-mail: b.s.wind@amc.uva.nl. Luiz H. Guimarães and Paulo R. L. Machado, Serviço de Imunologia, Hospital Universitário Professor Edgard Santos, Canela, Salvador, and Universidade Federal da Bahia, Salvador, Bahia, Brazil, E-mails: imuno@ufba.br and prlmachado@uol.com.br.

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