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January 2005

An Unusual Presentation of Cutaneous Leishmaniasis

Arch Dermatol. 2005;141(1):109-110. doi:10.1001/archderm.141.1.109

Cutaneous leishmaniasis (CL) usually presents with a skin ulcer caused by a sandfly bite and generally heals spontaneously within 3 to 6 months.1 We describe a patient with an atypical clinical form of CL that presented as an isolated submandibular mass.

A 88-year-old woman presented with a 2-month history of a painless left-sided submandibular mass, without other symptoms. She had a long history of hypertension, hypercholesterolemia, and coronary disease. She was not taking immunosuppressants. Physical examination showed a nontender, indurated mass, 3 cm in diameter, located in the left submandibular area and fixed to deep tissue. An isolated, ulcerative, and undated cutaneous lesion (<5 mm in diameter) with a raised and indurated border was also observed on the left side of the face. Laboratory test results were unremarkable. A chest x-ray film revealed cardiomegaly and pulmonary hypertension. A computed tomographic scan of the neck (Figure 1) with contrast showed significant enhancement of a 3.5 × 3.1-cm mass with an undefined border located in the posteroinferior pole of a parotid gland on the left side. Fine-needle aspiration of the mass yielded unspecific findings. Because a parotid neoplasm was suspected, a partial left parotidectomy and an excision biopsy of the cutaneous lesion were performed. The findings of histopathologic examination (Figure 2) of both lesions were diagnostic of leishmaniasis. Serologic tests were positive for Leishmania species (low titer) and negative for human immunodeficiency virus (HIV). One year later, there was no recurrence of disease.

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