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\begin{document}

\title{CUTANEOUS LEISHMANIASIS: A CASE REPORT OF A DIAGNOSTIC DILEMMA}



\author[1]{Prajwal Pudasaini}%
\affil[1]{Gandaki Medical College Teaching Hospital and Research Center Pvt Ltd}%


\vspace{-1em}



  
  \date{May 18, 2024}


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\selectlanguage{english}
\begin{abstract}
Cutaneous Leishmaniasis (CL) is the most prevalent clinical form of
leishmaniasis. CL is difficult for the clinicians to diagnose because of
the rarity of the disease and non-specific presentation. As CL is rare
and given the limitation of available diagnostic modalities in a
resource poor setting, diagnosis can be confusing.%
\end{abstract}%



\sloppy


\textbf{CUTANEOUS LEISHMANIASIS: A CASE REPORT OF A DIAGNOstic DILEMMA}

\textbf{Key Words} : Cutaneous Leishmaniasis, Fine Needle Aspiration
Cytology

Word count: 455 figure:1

Pudasaini P\textsuperscript{1}, Pudasaini P\textsuperscript{2}

\textsuperscript{1}Department of Dermatology, Gandaki Medical College
Teaching Hospital (GMCTH), Pokhara, Nepal, \textsuperscript{2}Department
of General Surgery, Kathmandu Medical College Teaching Hospital (KMCTH)

\textbf{Authors:}

Dr. Prajwal Pudasaini, Dr. Prashanta Pudasaini

Department of Dermatology Gandaki Medical College Teaching Hospital
(GMCTH), Pokhara, Nepal. Email: prajwalpudasaini@gmail.com Phone no:
+9779849447266

\textbf{Conflict of interest} : None

\textbf{Key clinical message:} Cutaneous Leishmaniasis (CL) is the most
prevalent clinical form of leishmaniasis and is caused by vector borne
protozoan parasite. Variation in diagnostic accuracy exists. A
54-year-old female farmer by occupation presented with lesion over right
thigh for 8 months.

Lesion evolved over period of 2-3 months and progressed to form ulcer
with surrounding redness. On examination, solitary plaque with
crateriform ulcer 3*2 cm in size roughly oval in shape was present.
Ulcer floor was moist, smooth shiny with serous discharge and well
defined raised erythematous margin was present. Biopsy was done which
showed features suggestive of lupus vulgaris, for which Anti Tubercular
Treatment (ATT) was started. There was persistence of ulcer despite 4
months of ATT, for which diagnosis was reconsidered and Fine Needle
Aspiration Cytology (FNAC) was performed. FNAC showed numerous intra and
extracellular amastigotes suggestive of Leishmaniasis which was treated
with complete disappearance of ulcer over 4 months.

\textbf{Abstract}

\textbf{Background} : Cutaneous Leishmaniasis (CL) is the most prevalent
clinical form of leishmaniasis and is caused by vector borne protozoan
parasite.\textsuperscript{1} Variation in diagnostic accuracy exists
between different parasitological and histopathological
examination.\textsuperscript{2} Test of choice for diagnosis depends not
only on the sensitivity and specificity of a test, but also the
availability, especially in a resource poor setting. CL is difficult for
the clinicians to diagnose because of the rarity of the disease and
non-specific presentation. Here we report a rare case report of CL.

\textbf{Observation} : A 54-year-old female from Gorkha, farmer by
occupation with frequent outdoor activities, presented with lesion over
right thigh for 8 months. Initially single pinhead sized, soft, raised
lesion with brownish red color was noted over right thigh that increased
in size with crust formation. Lesion evolved over period of 2-3 months
and progressed to form ulcer with surrounding redness. On examination,
solitary plaque with crateriform ulcer 3*2 cm in size roughly oval in
shape was present over the right thigh, upper third aspect in the
lateral part, approx.15cm from Anterior Superior Iliac Spine (ASIS).
Ulcer floor was moist, smooth shiny with serous discharge and well
defined raised erythematous margin was present. Biopsy was done which
showed features suggestive of lupus vulgaris, for which Anti Tubercular
Treatment (ATT) was started. There was persistence of ulcer despite 4
months of ATT, for which diagnosis was reconsidered and Fine Needle
Aspiration Cytology (FNAC) was performed. FNAC showed numerous intra and
extracellular amastigotes suggestive of Leishmaniasis which was treated
with complete disappearance of ulcer over 4 months.

\textbf{Discussion} : As CL is rare and given the limitation of
available diagnostic modalities in a resource poor setting, diagnosis
can be confusing. Diagnosis can be made with good clinical acumen and
FNAC in an endemic area.\textsuperscript{3} With proper diagnosis
overall prevalence of the disease can be estimated and clinical
therapeutic trials can be performed with timely prevention of
mucocutaneous complications.

Bibliography:

\begin{enumerate}
\tightlist
\item
  Cutaneous leishmaniasis: current and future management. \emph{Hepburn
  NC} \emph{Expert Rev Anti Infect Ther. 2003 Dec; 1(4):563-70.}
\item
  Current diagnosis and treatment of cutaneous and mucocutaneous
  leishmaniasis. \emph{Goto H, Lindoso JA Expert Rev Anti Infect Ther.
  2010 Apr; 8(4):419-33.}
\item
  Use of fine needle aspiration cytology in the diagnosis of cutaneous
  leishmaniasis: a comparison with the conventional scraping
  method.\emph{Hosseinzadeh M, Omidifar N, Lohrasb MH Trop Doct. 2012
  Apr; 42(2):112-3.}
\end{enumerate}\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/CL/CL}

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