Journal of Ophthalmic Inflammation and Infection (Aug 2024)

A case of adnexal cutaneous leishmaniasis in Washington DC

  • Sinan Akosman,
  • Heeyah Song,
  • Paul Sheils,
  • Tamer Mansour,
  • Keith J. Wroblewski,
  • Lamise Rajjoub

DOI
https://doi.org/10.1186/s12348-024-00423-z
Journal volume & issue
Vol. 14, no. 1
pp. 1 – 4

Abstract

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Abstract Purpose To report a rare non-endemic case of Leishmania aethiopica in Washington DC. Case report A 68-year-old female presented for a routine examination with a complaint of right upper eyelid lesions for the past 5 months. On examination, a cluster of elevated and erythematous lesions extending from the medial canthus to the brow area of the right eye were seen. Initial treatment with Valtrex based on a suspected viral etiology failed. Although a biopsy was recommended at this time, the patient declined, and subsequent workup included nasolacrimal duct irrigation, blood work to rule out autoimmune etiology, a course of doxycycline, and an MRI, which yielded no improvement. Upon progression of the lesions into persistent plaques on the eyelids, a punch biopsy was performed, confirming leishmaniasis. The patient was then started on a 28-day course of oral miltefosine which led to complete resolution of her symptoms. Conclusion This case underlines the importance of a broad differential including non-endemic diseases, particularly in urban areas with frequent patient travel. Furthermore, the delayed punch biopsy in this case highlights the importance of patient counseling to ensure prompt diagnosis and treatment.

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