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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