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CASE REPORT
Year : 2017  |  Volume : 18  |  Issue : 2  |  Page : 116-118

Cutaneous leishmaniasis of the eyelid: An uncommon presentation of a common entity


Treatwell Skin Centre, Jammu, Jammu and Kashmir, India

Date of Web Publication27-Mar-2017

Correspondence Address:
Mrinal Gupta
Treatwell Skin Centre, Canal Road, Jammu - 180 019, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-7250.203008

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  Abstract 

Cutaneous leishmaniasis (CL) is a protozoal disease usually caused by Leishmania major and Leishmania tropica and transmitted by the bite of a sandfly. It is usually characterized by a single, polymorphous lesion located in an uncovered area. The eyelid is rarely involved and only makes up 2.5% of cases with CL. We report a case of CL localized on the left lower eyelid in a 6-year-old girl. The disease was characterized by a single, asymptomatic nodule, which was managed as sty or eczema by various practitioners previously. The diagnosis was confirmed by the presence of Leishman-Donovan bodies on slit skin smear, and the patient was treated with intramuscular sodium stibogluconate. Complete clearance of lesions with residual scarring was seen after 3 weeks of therapy.

Keywords: Cutaneous leishmaniasis, eyelid, sodium stibogluconate, sty


How to cite this article:
Gupta M. Cutaneous leishmaniasis of the eyelid: An uncommon presentation of a common entity. Indian J Paediatr Dermatol 2017;18:116-8

How to cite this URL:
Gupta M. Cutaneous leishmaniasis of the eyelid: An uncommon presentation of a common entity. Indian J Paediatr Dermatol [serial online] 2017 [cited 2020 Sep 20];18:116-8. Available from: http://www.ijpd.in/text.asp?2017/18/2/116/203008


  Introduction Top


Leishmaniasis is a parasitic disease caused by Leishmania, transmitted by the bite of infected sandfly. Depending on the infecting Leishmania species and host immunocompetence, there are cutaneous, mucocutaneous, and visceral forms of the disease.[1] It is estimated that 350 million people are at risk of leishmaniasis and the disease, in its various forms, affects at least 12 million people worldwide, with 1.5–2 million new cases per year.[2]

Cutaneous leishmaniasis (CL) typically presents as a skin ulcer over exposed regions of the body after a sandfly bite. The eyelid is one of the rare sites of CL and is involved in only 2.5% of cases.[3] We present a case of CL arising over the lower eyelid of a 6-year-old girl, who was managed previously by various practitioners as sty and eczema.


  Case Report Top


A 6-year-old girl presented to us with a gradually progressive erythematous nodular lesion over the left lower eyelid for the last 3 months. The lesion had begun as a small papule which had progressed to its present size over the time, but had remained asymptomatic throughout the study. There was no history of any insect bite or thorn prick at the site. There was no history of any similar lesion in the family members, but the parents gave history of the presence of similar lesions over the face and arms in a few neighbors. There was no history of tuberculosis in the patient or any family member. The patient had consulted many practitioners previously and had been managed on the lines of sty and eczema without any clinical improvement.

On examination, a well-defined erythematous plaque of size 2 cm × 0.5 cm with well-defined margins, and central crusting was present on the left lower eyelid [Figure 1]. On palpation, the plaque was firm, indurated, and nontender. There were no ocular changes or any associated lymphadenopathy. Rest of the cutaneous and systemic examination was normal. On the basis of history and examination, differential diagnoses of lupus vulgaris, CL, and cutaneous sporotrichosis were considered.
Figure 1: Well-defined erythematous plaque with central crusting present on the left lower eyelid

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Routine laboratory investigations and radiological examination of the chest revealed no abnormality. A slit skin smear of the lesion, stained with Giemsa stain showed the presence of numerous Leishman-Donovan (LD) bodies [Figure 2] which confirmed the diagnosis of CL. The patient was started on intramuscular sodium stibogluconate at a dose of 20 mg/kg/day for 3 weeks, which led to a gradual improvement of the lesion. After 6 months of follow-up, there was presence of residual scarring at the site with no recurrence of the lesion.
Figure 2: Skin smear showing Leishman-Donovan bodies with Giemsa stain

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  Discussion Top


CL is a common parasitic disease with variable clinical manifestations, mostly involving the exposed sites with face, neck, and arms being the most commonly involved. CL of the eyelid is a rare entity, the low incidence on the eyelid being attributed to the frequent movements of the eyelid, which deter the insect from biting in this region.[4] Lid lesions may be caused by the bite, inoculation of the lid by the patient's fingers, lymphatic dissemination, or contiguous spread from a neighboring site.[5]

The lateral canthus is the most commonly affected site, and the most common clinical manifestation is a chalazion-like nodular lesion; however, presentations such as plaques, erosions, ulcers, phagedenic, and unilateral chronic granulomatous blepharitis have also been reported. Ocular leishmaniasis has also been reported to cause ptosis, lagophthalmos, ectropion, lacrimal discharge, blepharoconjunctivitis, nodular episcleritis, scleromalacia, ulcerative interstitial keratitis, anterior uveitis, and retinopathy.[4],[5],[6] The various ocular complications reported due to CL include palpebral scar, trichiasis, conjunctival scar, scleral perforation, corneal opacity, secondary glaucoma, and development of squamous cell carcinoma.[4],[5],[6] Ocular leishmaniasis is considered a potentially blinding disorder, and early diagnosis and treatment is imperative to prevent complications.[3]

In endemic areas, the clinical diagnosis is not difficult. Usually, this is best achieved by performing a smear of the material from the lesion and staining it with Wright or Giemsa stain which may reveal the presence of LD bodies. Histopathological examination of the lesion may also reveal LD bodies in early cases. Culture of the material in Novy-MacNeal-Nicolle medium or polymerase chain reaction may also be done for the confirmation of the diagnosis.

Numerous treatment modalities have been used for the management of CL. The more effective treatment is with pentavalent antimonial compounds or sodium stibogluconate, and the dosage recommended by the World Health Organization is 20 mg/kg/day over 3 weeks.[2] Other modalities include 20% paromomycin ointment, cryotherapy, liposomal amphotericin B, and oral antifungals.[2],[4]

Eyelid involvement, a rare presentation of CL, is a potentially blinding condition, which if not treated timely may lead to serious ocular complications. The practitioners in the endemic areas should be well aware of this presentation for early diagnosis, management, and prevention of complications.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
  References Top

1.
Bari AU, Rahman SB. Many faces of cutaneous leishmaniasis. Indian J Dermatol Venereol Leprol 2008;74:23-7.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Jafari AK, Akhyani M, Valikhani M, Ghodsi ZS, Barikbin B, Toosi S. Bilateral cutaneous leishmaniasis of upper eyelids: A case report. Dermatol Online J 2006;12:20.  Back to cited text no. 2
    
3.
Abrishami M, Soheilian M, Farahi A, Dowlati Y. Successful treatment of ocular leishmaniasis. Eur J Dermatol 2002;12:88-9.  Back to cited text no. 3
    
4.
Veraldi S, Bottini S, Currò N, Gianotti R. Leishmaniasis of the eyelid mimicking an infundibular cyst and review of the literature on ocular leishmaniasis. Int J Infect Dis 2010;14 Suppl 3:e230-2.  Back to cited text no. 4
    
5.
Sadeghian G, Nilfroushzadeh MA, Moradi SH, Hanjani SH. Ocular leishmaniasis: A case report. Dermatol Online J 2005;11:19.  Back to cited text no. 5
    
6.
Durdu M, Gökçe S, Bagirova M, Yalaz M, Allahverdiyev AM, Uzun S. Periocular involvement in cutaneous leishmaniasis. J Eur Acad Dermatol Venereol 2007;21:214-8.  Back to cited text no. 6
    


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