Differential diagnosis, investigations and treatment
Biopsy was taken from skin lesions with variable differential diagnoses such as psoriasis, sarcoidosis, sweet syndrome and mycobacterial infections and connective tissue diseases. Histopathology showed dense lymphohistiocytic infiltrates in the dermis. The histiocytes had foamy cytoplasm with numerous leishman bodies inside. (Figure 3)
Skin smears from four other lesions from different areas of the body were collected and investigated with Giemsa staining which showed numerous Leishmania amastigotes in all four areas. Polymerase Chain Reaction (PCR) test reported Leishmania. tropica species.
The patient received intramuscular Meglumine Antimoniate (Glucantime) injections, 20mg/kg/day. Improvement of clinical features was remarkable in ten days. Because of the increase in liver enzyme, the treatment was stopped for few days and restarted with a lower dosage and continued for 28 days.