Tropical/Infectoparasitary Dermatology
Plantar ulcer as an atypical manifestation of cutaneous leishmaniasis
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"tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "352" "paginaFinal" => "354" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Fernanda de Carvalho Tironi, Gustavo Uzeda Machado, Sergio Marcos Arruda, Paulo Roberto Lima Machado" "autores" => array:4 [ 0 => array:3 [ "nombre" => "Fernanda de Carvalho" "apellidos" => "Tironi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Gustavo Uzeda" "apellidos" => "Machado" "email" => array:1 [ 0 => "gumach@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Sergio Marcos" "apellidos" => "Arruda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Paulo Roberto Lima" "apellidos" => "Machado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Universidade Federal de São Paulo, São Paulo, SP, Brazil" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Escola Bahiana de Medicina, Salvador, BA, Brazil" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Fundação Oswaldo Cruz, Salvador, BA, Brazil" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Universidade Federal da Bahia, Salvador, BA, Brazil" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1029 "Ancho" => 755 "Tamanyo" => 101262 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ulcer with raised edges on the left plantar region.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">American Tegumentary Leishmaniasis (ATL) is an endemic, neglected, and important disease in Brazil. ATL, whose main agent in our country is <span class="elsevierStyleItalic">Leishmania braziliensis</span>, it is characterized by several clinical manifestations, resulting in mucocutaneous involvement, in addition to disseminated and atypical forms.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> The disease pathogenesis is the result of the interaction between the genetic polymorphism of the parasite, host immune response, and environmental conditions, resulting in different clinical presentations.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Cutaneous Leishmaniasis (CL) is the most prevalent clinical presentation and is characterized by one or more rounded ulcers, with a granular bottom and raised edges, located mainly in exposed parts of the skin, corresponding to the parasite inoculation site by the vector insect.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> The presence of lesions in less accessible body areas such as the scalp, genital region, or palmoplantar location, constitutes an atypical manifestation of the disease.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Plantar ulcers in the absence of disseminated disease in ATL are extremely uncommon and should be differentiated from other etiologies, including leprosy and perforating disease associated with diabetes, thus being an important differential diagnosis in endemic areas of leishmaniasis.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case report</span><p id="par0015" class="elsevierStylePara elsevierViewall">A twenty-one-year-old male patient was referred to the Corte de Pedra Leishmaniasis Reference Center in the municipality of Presidente Tancredo Neves, in the state of Bahia, Brazil. He was previously healthy and had no report of chronic diseases or previous history of ulcerated skin lesions suspected of leishmaniasis. He observed the sudden appearance of a papular and ulcerated lesion in the axillary region with approximately 35 days of evolution. Concomitantly, he had an ulcerated lesion with raised edges on the left plantar region, associated with fever and myalgia. He subsequently evolved with the formation of two erosive lesions in the groin and left buttock regions 20 days after the onset of the manifestations, with lymphadenopathy in the left inguinal region. The physical examination showed a rounded ulcer with a granular bottom on the plantar region of the left foot measuring 11 × 15 mm (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) and three ulcerated papules in the left axilla, buttock, and groin region. The biopsy of the plantar ulcer edge showed positive PCR for <span class="elsevierStyleItalic">L. braziliensis</span> and the histopathological analysis showed the presence of amastigotes of <span class="elsevierStyleItalic">L. braziliensis</span> (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Treatment with meglumine antimoniate was implemented for 30 days, and the patient showed complete regression of the skin lesions and full healing of the plantar ulcer.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion</span><p id="par0020" class="elsevierStylePara elsevierViewall">The classical presentation of CL comprises a round ulcer with raised edges and a granular bottom, located mainly in exposed regions, which correspond to the parasite inoculation site by the vector insect. Ulceration on the plantar region is characterized as an atypical manifestation of cutaneous leishmaniasis. Few reports have been described in the literature since it represents an area of the skin where the thickness of the corneal layer and difficulty of access make inoculation by the vector unfeasible.</p><p id="par0025" class="elsevierStylePara elsevierViewall">During the investigation of the condition, it is important to consider differential diagnoses such as leprosy, vasculitis, and chronic ulcers due to vascular insufficiency or diabetes. The histopathological analysis with evidence of the protozoan presence in the affected tissue and confirmatory PCR analysis are essential in these cases for diagnostic confirmation and implementation of adequate curative treatment.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0030" class="elsevierStylePara elsevierViewall">None declared.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors’ contributions</span><p id="par0035" class="elsevierStylePara elsevierViewall">Fernanda de Carvalho Tironi: Study design and planning; drafting and editing of the manuscript; critical review of the manuscript.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Gustavo Uzeda Machado: Approval of the final version of the manuscript; effective participation in the research orientation.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Sergio Marcos Arruda: Collection, analysis, and interpretation of data; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Paulo Roberto Lima Machado: Approval of the final version of the manuscript; collection, analysis, and interpretation of data; effective participation in the research orientation; intellectual participation in the propaedeutic and/or therapeutic conduct of the studied cases; critical review of the manuscript.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1521068" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1379244" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Financial support" ] 6 => array:2 [ "identificador" => "sec0025" "titulo" => "Authors’ contributions" ] 7 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2019-12-17" "fechaAceptado" => "2020-06-30" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1379244" "palabras" => array:4 [ 0 => "Cutaneous leishmaniasis" 1 => "Leishmaniasis" 2 => "Plantar ulcer" 3 => "Ulcer" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Cutaneous leishmaniasis is characterized by ulcers with raised edges and a granular bottom, mainly on the lower limbs. This is a case report of a male patient with an ulcer on the left plantar region. The diagnosis was confirmed by positive PCR for <span class="elsevierStyleItalic">L. braziliensis</span> and the presence of amastigotes of <span class="elsevierStyleItalic">Leishmania sp</span>. in the histopathological examination. After treatment with Glucantime, the patient showed full healing of the ulcer. The unusual location of the ulceration calls attention to atypical presentations of leishmaniasis, and the importance of histopathological examination and PCR, leading to the appropriate diagnosis and treatment.</p></span>" ] ] "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">How to cite this article: Tironi FC, Machado GU, Arruda SM, Machado PRL. Plantar ulcer as an atypical manifestation of cutaneous leishmaniasis. An Bras Dermatol. 2021;96:352–4.</p>" ] 1 => array:2 [ "etiqueta" => "☆☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Study conducted at the Immunology Service, Hospital Universitário Professor Edgard Santos, Salvador, BA, Brazil.</p>" ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1029 "Ancho" => 755 "Tamanyo" => 101262 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Ulcer with raised edges on the left plantar region.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 577 "Ancho" => 750 "Tamanyo" => 99831 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Anatomopathological examination of a plantar ulcer showing dermal infiltrate and amastigotes of <span class="elsevierStyleItalic">L. braziliensis</span> inside macrophages (arrow). (Hematoxylin & eosin, ×100).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Disseminated leishmaniasis: clinical, pathogenic and therapeutic aspects" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.U. Machado" 1 => "F.V. Prates" 2 => "P.R.L. Machado" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1590/abd1806-4841.20198775" "Revista" => array:6 [ "tituloSerie" => "An Bras Dermatol" "fecha" => "2019" "volumen" => "94" "paginaInicial" => "9" "paginaFinal" => "16" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30726457" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Atypical manifestations of cutaneous leishmaniasis in a region endemic for Leishmania braziliensis: clinical, immunological and parasitological aspects" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L.H. Guimarães" 1 => "A. Queiroz" 2 => "J.A. Silva" 3 => "S.C. Silva" 4 => "V. Magalhães" 5 => "E.L. 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| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 16 | 6 | 22 |
| 2024 Outubro | 128 | 99 | 227 |
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| 2024 Maio | 93 | 61 | 154 |
| 2024 Abril | 107 | 71 | 178 |
| 2024 Março | 117 | 85 | 202 |
| 2024 Fevereiro | 112 | 85 | 197 |
| 2024 Janeiro | 86 | 45 | 131 |
| 2023 Dezembro | 88 | 71 | 159 |
| 2023 Novembro | 97 | 78 | 175 |
| 2023 Outubro | 83 | 77 | 160 |
| 2023 Setembro | 122 | 69 | 191 |
| 2023 Agosto | 71 | 50 | 121 |
| 2023 Julho | 75 | 37 | 112 |
| 2023 Junho | 65 | 42 | 107 |
| 2023 Maio | 46 | 21 | 67 |
| 2023 Abril | 36 | 18 | 54 |
| 2023 Março | 66 | 52 | 118 |
| 2023 Fevereiro | 54 | 43 | 97 |
| 2023 Janeiro | 51 | 48 | 99 |
| 2022 Dezembro | 64 | 29 | 93 |
| 2022 Novembro | 95 | 62 | 157 |
| 2022 Outubro | 105 | 60 | 165 |
| 2022 Setembro | 63 | 62 | 125 |
| 2022 Agosto | 48 | 50 | 98 |
| 2022 Julho | 48 | 50 | 98 |
| 2022 Junho | 54 | 55 | 109 |
| 2022 Maio | 39 | 57 | 96 |
| 2022 Abril | 53 | 50 | 103 |
| 2022 Março | 56 | 77 | 133 |
| 2022 Fevereiro | 47 | 41 | 88 |
| 2022 Janeiro | 71 | 76 | 147 |
| 2021 Dezembro | 59 | 71 | 130 |
| 2021 Novembro | 70 | 92 | 162 |
| 2021 Outubro | 55 | 88 | 143 |
| 2021 Setembro | 57 | 73 | 130 |
| 2021 Agosto | 73 | 66 | 139 |
| 2021 Julho | 68 | 59 | 127 |
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