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Systemic lupus erythematosus vs epidemic

infection, challenge to diagnose.

Areej A. S. Khatib. MDIAH Pathology & clinical labs head department . Ramallah . Palestine

Assistant professor, Bethlehem University

I have nothing to disclose

Case History:

• M. A is a 46 year old diabetic gentleman diagnosed with systemic lupus erythematosus (SLE) since 3 years, on Prednisone 7.5 mg / day and Metformin 850mg/day .

• Presented complaining of 2 skin lesions on the right leg on the extensor surface

• the lesion were circular and raised with ulcerative centers, itching marks seen around them.

• The patient mentioned similar lesions on other parts of the body that appear every now and then as part of his disease.

• The dermatologist first impression was an SLE flare up. He increased the dose of steroids.

The patient came back 2 days after that with more than 6 similar lesions on both legs

4x H&E

40 x

100x H&E

Giemsa-stained sectionsAmastigotes were demonstrated

• The lesions were diagnosed as leishmaniasis

• Retrospectively the patient documented being in a picnic in Jericho, one of the known area to be populated by leishmaniosis.

• The patient was given infiltration of sodium stibogluconate (Pentostam) for 2 months without response.

• The lesions flared up and various therapy modules including plasma rich platelets infusions, and local topical antibiotics with daily dressing continued for 6 month, the lesions healed after 8 months.

Lesions after 8 months…

Background• Leishmaniasis is a parasitic

infection caused by different species of Leishmania protozoa. >53 species identified.

• It is transmitted through the bite of infected female sandflies95 species identified

• They are very tiny silent flyers –they do not hum – and their bite might go unnoticed.

• Ryan KJ; Ray CG (editors) (2004). Sherris Medical Microbiology (4th ed.).

Background

Or animal vectors

Aronson , Clinical Infectious Diseases ,2016

WHY

.

WHO 2014

2006

It is increasing due to immigration IN & tourism OUT

• Imported leishmaniasis in The Netherlands from 2005 to 2012: epidemiology, diagnostic techniques and sequence-based species typing from 195 patients

July 2013, Eurosurveillance

And lastly ….to notice that

• Immunocompromised host has higher incidence for VL

• Treatment is not always successful.

• It can relapse

• It can spread