American tegumentary leishmaniasis: an uncommon clinical\nand histopathological presentation
In September 2010, a 42-year-old male patient from a rural area in Ceará noticed the\nonset of a nodule on his ear. Over the ensuing months, there was a minimal swelling of\nthe lesion. Treatment with topical steroids and antibiotics produced no improvement.\nPhysical examination revealed an erythematous nodule of fibrous-elastic tissue on the\nright ear lobe with no purulent discharge. The patient, with no history of local trauma,\ndid not experience localized pain, itching or constitutional symptoms ().\nThe patient´s blood glucose was normal and the VDRL test was nonreactive. Serologic\ntests for HIV were not undertaken. A biopsy was carried out about six months after the\nonset of the clinical condition.\nThe histological sections showed epithelial atrophy, and Grenz's zone in the dermis,\nwith a dense superficial and deep lymphoplasmacytic and histiocytic infiltrate. A large\nnumber of structures consistent with Leishmania sp. amastigotes was\nobserved in macrophages. The results of the Leishmanin skin test (LST) were positive,\nwith 10 mm of induration ( and ).\nThe patient missed follow-up but returned three months later with no changes on the\nlesion. Since no abnormalities were found in the general laboratory tests, treatment was\nstarted with meglumine antimoniate (15mg/kg) over 20 days. Two months after the end of\ntherapy the lesions showed clear signs of regression ().