(28) Man returned from Uzbekistan. A month after the return, against the background of low-grade fever, a tubercle appeared in the region of the left cheek, then a furunculo-like infiltrate, and soon a crater-like ulcer formed with a bottom covered with pus, along the edges of which there was a thick infiltrate. Put diagnosis Visceral Leishmaniosis Dermal Leishmaniosis Malaria African trypanosomiases American trypanosomiases
Reading File
Finding Sources
Reading File
Reading File
Answer: Dermal (Cutaneous) Leishmaniasis
This is the correct diagnosis. Here is the reasoning:
Key Clinical Features in This Case
| Feature | Significance |
|---|---|
| Travel to Uzbekistan | Endemic region for Leishmania tropica ("dry" urban type) and L. major ("wet" rural type) — both cause Oriental sore |
| 1-month incubation | Consistent with cutaneous leishmaniasis (subacute onset over weeks–months) |
| Tubercle → furuncle-like infiltrate | Classic early progression of the cutaneous leishmanial lesion |
| Crater-like ulcer with purulent base | Characteristic "volcano crater" ulcer of cutaneous leishmaniasis |
| Thick infiltrated edges | Firm induration around the ulcer is an almost constant feature of cutaneous leishmaniasis |
Why the Other Options Are Wrong
- Visceral leishmaniasis (Kala-azar) — affects internal organs (spleen, liver, bone marrow); presents with fever, splenomegaly, and wasting — no skin ulcer
- Malaria — causes cyclical fever, hemolytic anemia, hepatosplenomegaly — no skin lesions
- African trypanosomiasis — causes a trypanosomal chancre at the bite site + lymphadenopathy + sleeping sickness — Africa, not Central Asia
- American trypanosomiasis (Chagas) — causes Romaña's sign or chagoma, cardiac/GI complications — Americas only
Pathophysiology
Leishmania tropica (Central Asia) is transmitted by sandfly (Phlebotomus spp.) bite. The parasite invades dermal macrophages, forming amastigotes locally. The lesion progresses: papule → nodule → furuncle-like infiltrate → crater ulcer with firm indurated edges. This is called Oriental sore or Baghdad boil.
"A lesion that reaches its maximum size in less than a week is most likely not due to cutaneous leishmaniasis... firm infiltration is almost constant." — Goldman-Cecil Medicine
This is a shared conversation. Sign in to Orris to start your own chat.