Journal of Islamic International Medical College (Mar 2023)
Non-Caseating Granulomas in Skin Biopsies of Leishmania Cases
Abstract
Objective: To determine the frequencies of different types of granulomas in patients suffering from cutaneous leishmaniasis. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Armed Forces Institute of Pathology, Combined Military Hospital, Rawalpindi, Dec 2021 to Oct 2022. Materials and Methods: This study was conducted on 290 patients suffering from cutaneous leishmaniasis. Patients aged between 18 and 70 years of both genders were included, while those who had already received treatment for leishmaniasis, or suffered frommucocutaneous or visceral leishmaniasis were excluded. All patients underwent a punch biopsy, tissue which was stained with hematoxylin and eosin, and then studied for the presence of granulomas and Parasitic Index. PCR was done to confirm species of Leishmania causing disease. Data was analyzed using SPSS 26.0. Results: Our study population had a median age of 38.00 (16 - 63) years, with a male majority: 185 (63.8%). Granuloma formation was seen in 185 (63.8%) patients: 121 (41.7%) had a tuberculoid granuloma and 13 (4.5%) had suppurative granulomas, while 51 (17.6%) had caseating ones. L. Tropica was the most seen organism accounting for 255 (87.9%) cases, L. Major was the infective organism in 26 (9.0%) patients, while L. Infantum was found in 9 (3.1%) cases. Factors such as gender (p=0.273), age of the patient (p=0.901), disease duration (p=0.366), site of lesion (p=0.669), type of skin lesion (p=0.490), parasite index (p=0.297) and species of Leishmania (p=0.870) did not have any significant association with the development of non-caseating granulomas. Conclusion: Chronic granulomatous inflammation is a common finding on histopathology in cutaneous leishmaniasis and vigilance is required to avoid confusion with other endemic granulomatous skin conditions.
