{"id":1446611,"date":"2020-06-08T11:21:06","date_gmt":"2020-06-08T09:21:06","guid":{"rendered":"https:\/\/staging-wp-int.laboklin.com\/papular-dermatitis-a-clinical-case-of-leishmaniosis\/"},"modified":"2025-07-29T13:11:41","modified_gmt":"2025-07-29T11:11:41","slug":"papular-dermatitis-a-clinical-case-of-leishmaniosis","status":"publish","type":"post","link":"https:\/\/laboklin.com\/fi\/papular-dermatitis-a-clinical-case-of-leishmaniosis\/","title":{"rendered":"Papular dermatitis: a clinical case of Leishmaniosis"},"content":{"rendered":"

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Clinical history<\/h2>\n

Hass, an 18-month-old male, mixed-breed dog weighing 42 kg, was presented with a six-month history of a rash on his legs and ears. The condition did not bother him but was not improving. The animal was happy and active. He had been treated with corticosteroids showing slight improvement during the treatments. He was off from medication for a month, and the condition was spreading. A fortnight ago, he received an injection of Ivermectin. He lived in a house with a garden with two other dogs without lesions and had no ectoparasite protection (Fig. 1).<\/p>\n

Dermatological examination<\/h2>\n

Dermatological examination showed an extensive papular reaction with marked erythema of all extremities, more intense on distal areas to the elbow and inter-pad and inter-digital areas. There was partial June 2020 alopecia and foci of exudation with scabs. The extremities were slightly edematous. On the abdomen and in the pinna, there was a diffuse erythematous micro-papular rash.
\nThere was no pruritus or pain associated to the affected areas, no pruritic reflex when rubbing the lesions or the trunk (negative truncal pedal reflex).
\nThe popliteal lymph nodes were slightly enlarged, but there was no notable lymphadenopathy (Fig. 2).<\/p>\n

Dermatological pattern<\/h2>\n

The dermatological pattern was defined as: severe erythematous papular dermatitis affecting the extremities, abdomen and pinna, with alopecia in extremities and no pruritus.<\/p>\n

Differential diagnoses<\/h2>\n

The suggested differential diagnoses were: erythema multiforme, contact dermatitis, Leishmaniosis, Borreliosis, Ehrlichiosis, Filariasis, lymphedema, eosinophilic mucinotic mural folliculitis, demodicosis or bacterial folliculitis.<\/p>\n

Diagnostic tests<\/h2>\n

Trichography<\/strong> revealed no parasites, no fungal elements and no lesions compatible with fungal infection. The anagen\/telogen index was 1\/1.
\nNo bacteria or Malassezia sp. were found on superficial skin cytology<\/strong>.
\nFour 8 mm skin punch biopsies<\/strong> were obtained. The histopathological study revealed a mononuclear dermatitis from nodular to diffuse with the presence of Leishmania amastigotes inside macrophages (Fig. 3).<\/p>\n

A complete leishmania profile<\/strong> showed normal haematological and biochemical values, except for alterations in protein electrophoresis with hypoalbuminaemia and hyperglobulinaemia. The A\/G ratio was 0.30 (Table 1). The antibody titer against Leishmania by IFA was 1\/3200.
\nA rapid test for Borrelia<\/em> sp., Ehrlichia<\/em> sp., Filaria<\/em> sp. and Anaplasma<\/em> sp. was negative.<\/p>\n

Diagnosis<\/h2>\n

Leishmaniose<\/p>\n

Treatment<\/h2>\n

Treatment was started with 600 mg Allopurinol every 12 h and Glucantime\u00ae (Meglumine Antimoniate) SC – 14ml every 24h for four weeks (Fig. 4).<\/p>\n

Outcome<\/h2>\n

At the end of the Glucantime\u00ae treatment (day 28), all the lesions had resolved. After 60 days of treatment, protein electrophoresis showed normalisation of all values. The therapy with Allopurinol was maintained for four months, at that time, the proteinogram was in range, and the leishmania antibody titer was reduced to half. Subsequent controls were maintained in normal range, and the animal has not suffered any subsequent relapse, the antibody titer being negative.<\/p>\n

Discussion<\/h2>\n

Leishmaniosis is a zoonotic disease, endemic in Mediterranean countries. Leishmania infantum<\/em> is responsible for practically all cases of Leishmaniosis in Europe. Phlebotomus sp. is the insect vector, which inoculates the flagellated promastigotes, the infective form of the parasite. Once in the skin, the promastigotes lose the flagella and transformed into amastigotes.[\/vc_column_text][\/vc_column][vc_column width=”1\/3″][vc_column_text]<\/p>\n\n\t\t\t