Combination of Surgical Excision and Liposomal Amphotericin B for the Treatment of Cutaneous Leishmaniasis-A Case Report and Review Literature

結合手術切除及amphotericin B治療皮膚型利什曼原蟲症－案例及文獻討論

Chih-Chao Chuang(莊智超) ； Chang-Lin Chen(陳長齡) ； Chih-Yi Hsu(許志怡) ； Shiang-Fen Huang(黃祥芬) ； Yu-Jen Chiu(邱宇任)

《臺灣整形外科醫學會雜誌》 31卷4期 (2022/12) Pp. 314-321

摘要

Background: Cutaneous leishmaniasis (CL) is a parasitic disease endemic in Africa, southwest Asia, and Central and South America and is spread by sand flies. It is very rare in non-epidemic areas, such as Taiwan. It can be caused by different Leishmania species with various prognoses and therapy responses. Generally, treatment is divided into local and systemic therapies, but surgical excision is seldom performed. Aim and Objectives: We present a rare case of CL based on clinical diagnosis, management, literature review, and discussion of the differential diagnoses of chronic skin ulcers. Materials and Methods: A 70-year-old male presented with a chronic ulcer on his left forearm. Pathological examination revealed a typical protozoan infection. The patient underwent systemic therapy with liposomal amphotericin B, followed by surgical excision. Results: Polymerase chain reaction (PCR) showed Leishmania braziliensis, compatible with protozoan infection. There was satisfactory treatment efficacy and wound scarring with surgical excision and liposomal amphotericin B. Conclusion: No single treatment is suitable for all Leishmania species. PCR was used to identify the species for appropriate treatment. Plastic surgeons should consider the differential diagnosis of atypical cutaneous lesions, especially in patients with a travel history to specific regions.

關鍵字

leishmania ； cutaneous leishmaniasis ； liposomal amphotericin B (Short title/Running title): Combination of Excision and Liposomal Amphotericin B for Cutaneous Leishmaniasis

並列摘要

背景：皮膚型利什曼原蟲症是一種由沙蠅傳播的疾病，常見分佈於非洲、西南亞、中美洲及南美洲，在其他區則是非常罕見。利什曼屬的原蟲類非常多種，每一種的預後和治療效果都不盡相同，治療主要可分為局部及系統性，手術切除則是比較少被提及。目的及目標：本篇提出一位皮膚型利什曼原蟲症病例報告，希望透過臨床診斷及治療這位患者的經驗，討論醫學文獻，讓臨床醫師熟悉此疾病。材料及方法：本篇病例報告提出一位70歲男性，具有中南美洲旅遊史，於旅遊期間發現左前臂出現一久不癒合之皮膚潰瘍病兆，病理切片顯示為原蟲感染。他接受微脂粒amphotericin B的注射以及手術切除。結果：根據病理切片，聚合酶連鎖反應顯示為Leishmania braziliensis，符合原蟲類感染的診斷。採用手術切除及藥物注射得到滿意的治療效果和傷口疤痕。結論：目前沒有一種能對所有利什曼原蟲症都有效的治療，因此採用聚合酶連鎖反應來辨識利什曼原蟲症的種類相當重要。當臨床醫師看到非典型的皮膚病兆時，可以考慮進一步的詢問旅遊史，做出適當的鑑別診斷，將幫助病患儘早發現及時治療。