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Official Journal of the Italian Society of Dermatology and Sexually Transmitted Diseases
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Satta R., Montesu M. A., Satta G. *, Cottoni F.
Università degli Studi - Sassari Clinica Dermatologica
* Istituto Zooprofilattico della Sardegna - Sassari
Leishmania major (LM) is the etiological agent of wet or rural cutaneous leishmaniasis. Man is an accidental host in the biological cycle of this zoonosis, which includes an insect carrier and a mammal reservoir. LM has an endemic distribution in vast areas of the Middle East, with hyperendemic foci reported in Syria and other regions. Between 4 and 8 cases of rural cutaneous leishmaniasis caused by LM are reported in Italy every year. None of these cases is autochthonous. All the reported cases are imported and occur in subjects who have stayed in endemic areas for LM or in foreign immigrants from the same regions. The authors report the case of a 61-year-old man who was referred to our attention owing to the presence of multiple papulonodular lesions tending to ulceration, localised in the areas not covered by clothing. The patient reported that he had been repeatedly bitten by blood-sucking insects about four months before the appearance of the lesions while staying in Syria. A histological test was performed on one of the lesions with an ulcerated dermal nodule with extensive areas of abscess and intense histiocytic infiltrate. Numerous Donovan bodies were present in the histiocytic context. Having diagnosed Leishmaniasis, the authors proceeded to identify the biochemical nature of the strain, leading to the identification of Leishmania major (LM) zymodema Montpellier 26. Systemic treatment with N-methyl-glucamine 60 mg/km/die for 20 consecutive days, with daily monitoring of electrolytes and electrocardiogram, led to the complete resolution of lesions. No recurrence has been reported more than 1 year later. The authors felt that this case of leishmaniasis was worth reporting in view of the growing interest in imported pathologies which are steadily increasing due to the frequency of intercontinental travel for work and pleasure, and the constant flow of immigrants from areas with endemic transmissible pathologies.