Images in Clinical Tropical Medicine Disseminated Dermal Leishmaniasis Caused by Leishmania siamensis In a Systemic Steroid Therapy Patient

Abstract. Leishmania siamensis infection was recently reported from Thailand. Clinical presentation of L. siamensis infections is generally related to human immunodeficiency virus infection. Herein, disseminated dermal L. siamensis infection in a systemic steroid therapy patient from Myanmar is described. A 60-year-old male Burmese living in Yangon had never traveled abroad. He developed fever, multiple infiltrative ery-thematous nodules on his body 3 months before coming to Thailand. He visited a physician in Yangon and was diagnosed as Sweet’s syndrome. The patient was treated with prednisolone for 2 months without improvement. Repeat biopsy showed diffuse histiocytic infiltrate and multi-nucleated giant cells in the upper and deep dermis. Many rounds to oval small organisms were present in histiocytes and fibrous stroma. He was diagnosed as histoplasmosis and was treated with itraconazole, his general condition was improving, however the cutaneous lesions worsened (Figure 1A and B)