Atypical clinical form of cutaneous leishmaniasis: erysipeloid form

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Abstract
A 60‐year‐old woman was admitted to our clinic with a gradually enlarging red papule on her face. Her history revealed that, 9 months previously, a painless, red papule of 1–2 cm in diameter had occurred in the middle of her face and, with time, had enlarged to cover her nose, both cheeks, and eyelids. It was diagnosed as a superficial skin infection, and topical and systemic antibiotics were prescribed; however, no response was obtained. In the last 2 months, a sore had formed in the middle of her nose. The patient lives in the east of Eastern Anatolia, where no case of cutaneous leishmaniasis has been reported in the last 20 years.On dermatologic examination of the patient, an erythematous, indurated, slightly squamous, 10 cm × 5 cm, butterfly‐shaped plaque with sharply defined borders was seen on both cheeks, lower eyelids, and the whole nose (Fig. 1). In smears taken from the lesion, a number of amastigotes belonging to Leishmania were determined in the intracellular and extracellular area (Fig. 2). Histopathologic examination of the cutaneous lesion showed scattered infiltration composed of mononuclear cells, histiocytes, plasma cells, and small epithelioid granulomas. Gram smear and anaerobe–aerobe culture prepared from the lesion were negative. The total blood count and sedimentation rate of the patient were within normal limits. Routine biochemical tests, urine analysis, chest radiography, and intradermal purified protein derivative (PPD) skin test were all normal. Antinuclear antibody and antistreptolysin antibody examinations were negative. Butterfly‐shaped infiltrated erythematous plaque on the face image Smear from the lesion showing a number of amastigotes in the intracellular and extracellular area (Giemsa‐stained smear; original magnification, ×100; with immersion oil) image The patient was treated intramuscularly with 10 mg/kg/day systemic meglumine antimoniate, divided into two doses, for 20 days, with good control.

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