Cutaneous leishmaniasis mimicking sarcoidosis in Libyan patient: A case report

Leishmaniasis is vector–borne disease caused by parasitic protozoans belonging to the genus Leishmania and is transmitted by infected phlebotomine sand flies . Sarcoidosis is a multisystemic disorder of unknown cause characterized by the formation of immune granulomas in affected organs. Clinical symptoms, severity and evolution of sarcoidosis are highly heterogeneous and can lead to other diseases with similar clinical and pathologic presentations. In this report we present a case of 77 years-old diabetic Libyan male, with chronic erythematous indurated plaques, and nodules on the face. The patients were treated by multiple physicians with topical and systemic corticosteroids for 25 years without improvement. Microscopic examination of Giemsa stained smears from all lesions showed numerous Leishmania amastigotes in and outside monocytes. Leishmania tropica was identified as causative species. The patient was treated with combination of oral rifampicin (600 mg/day) and isoniazide (300 mg/day) and followed up for 9 months until skin-slit smears and PCR turned negative. In conclusion, CL can be misdiagnosed clinically with any granulomatous skin lesions which are compatible with sarcoidal type granuloma. Molecular diagnosis of CL by implementing Leishmania -specific PCR approaches should be performed routinely in any granulomatous skin lesion.