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.