Image 50: This child presented with a tiny pimple on the bridge of her nose that grew slowly over a year to this 5 mm diameter. It was diagnosed in Europe and Canada as a plasmocytoma in part because there was a positive Darier's sign (increased redness and swelling when lesion was rubbed). She received a steroid cream for 3 months and it grew rapidly to the large crusting non-painful non-tender lesion of 2 cm. She had never been outside Europe or North America, but had visited Majorca several months before the first tiny (1 mm) papule had appeared. What is diagnosis?

50

Image 50: The lesion, biopsied at the Wuerzberg Tropical Medicine Clinic in Germany, proved to be a leishmaniasis, and a PCR on the fixed biopsy material  by Dr Thomas Weitzel, Berlin Institute of Tropical Medicine was positive for Leishmania donovani. Because dermatological L. donovani found in southern France and Spain is Leishmania donovani infantum, the diagnosis of this case is cutaneous L. infantum. Dr Gustl Stich treated her successfully with 28 days of Miltifosine. 

6 months post Miltifosine

May 7, 2007