[Chronic facial ulceration in France and potential involvement of Leishmania infantum cutaneous leishmaniasis].

Annales de dermatologie et de venereologie

PubMedID: 24206806

Lenvers P, Marty P, Peyron F. [Chronic facial ulceration in France and potential involvement of Leishmania infantum cutaneous leishmaniasis]. Ann Dermatol Venereol. 2013;140(11):704-7.
BACKGROUND
In France, cutaneous leishmaniasis is frequently seen in patients returning from North Africa or South America. Autochthonous leishmaniasis due to Leishmania infantum causes rather visceral forms. Nevertheless, cutaneous leishmaniasis caused by this parasite is occasionally seen in immunocompetent patients who have never been outside France.

PATIENTS AND METHODS
An 8-year-old girl living in the Haute-Savoie region and who had never travelled overseas presented with chronic ulceration of the right cheekbone that failed to regress under topical therapy. Laboratory tests demonstrated the presence of L. infantum. Following cryotherapy and intralesional injections of meglumine antimonite, the lesion resolved within a month. The patient's medical history revealed repeated journeys to the Pyrénées-Orientales region of southern France.

DISCUSSION
For chronic ulceration on an uncovered area that does not resolve with topical therapy, cutaneous leishmaniasis should be considered in the differential diagnosis even if the patient has never left France. Trips to the South of France (an endemic region) should be sought in the history. In addition to direct examination of the product from curettage of the lesion and histopathology, non-invasive methods such as Western blotting with PCR run on filter paper impressions allow accurate diagnosis.