Panniculitis in Cutaneous Leishmaniasis: a Study in Sri Lanka


Panniculitis in Cutaneous Leishmaniasis: a Study in Sri Lanka

Thilakarathne BMIK, Ratnayake RMP, Vithanage A, Sugathadasa WDP

Department of Pathology, Teaching Hospital, Kandy, Sri Lanka.


International-Journal-of-Case-Reports-2d code

Introduction: Panniculitis is the inflammation of subcutaneous adipose tissue which is caused by many infectious and inflammatory conditions. It is high time to document panniculitis in the skin lesions with cutaneous leishmaniasis (CL) in Sri Lanka.
Objectives: This study was performed to assess demographic data and to describe panniculitis in patients with CL.
Methods: A descriptive cross-sectional study was done from 2013 to March 2018 at Teaching Hospital Kandy, Sri Lanka. The skin biopsies clinically suspected as CL evaluated histologically for diagnostic or indicative evidence of CL, and patients responded completely to the specific anti-leishmaniasis treatment were taken as the study population. Skin biopsies of 123 patients were assessed in view of dermal granulomata, Leishman-Donovan bodies and panniculitis.
Results: The majority of patients were in the age group of 36 to 50 years (N= 36:29.3%: mean=41.64 years: SD18.15 years) and there was a slight female predominance in the study (N=65:52.8%). A majority of skin biopsies revealed Granulomata (N=95: 77.2%). Leishmania Donovan bodies were identified among 43.1% of the lesions (N=53). Though there were 123 patients, only 66 (53.6%) skin biopsies were deeper enough to reveal subcutaneous tissue. A significant amount of skin lesions showed subcutaneous tissue inflammation (N=59:89.39%), predominantly non-granulomatous in morphology (N=44:74.6%).
Conclusion: Subcutaneous tissue inflammatory infiltrate in the non-granulomatous morphology is an important feature of the skin biopsies of CL especially in the granulomatous variant of the CL, which can be achieved by a deeper elliptical biopsy.


Keywords: Cutaneous leishmaniasis, Panniculitis, Subcutaneous tissue, Granulomata, Leishman-Donovan bodies.


Free Full-text PDF


How to cite this article:
BMIK Thilakarathne; RMP Rathnayake; A Vithanage; WDP Sugathadasa. Panniculitis in Cutaneous Leishmaniasis: a Study in Sri Lanka. International Journal of Case Reports, 2018 3:52. DOI:10.28933/ijcr-2018-11-2608


References:

1. WHO technical report series 949. Control of the leishmaniasis, Report of a meeting of the WHO expert committee on the control of leishmaniasis. 2010; 1-179.
2. Chatterjee KD. Parasitology, Protozoology and Helminthology. 13th ed. CBS publishers & distributors Pvt. Ltd. 2009; 64-89.
3. Sujeevi SKN, Danister JW, Chandana JW, Dissanayake M, Rajapaksha K. Cutaneous Leishmaniasis, Sri Lanka. Emerging Infectious Diseases. 2007; 13 (7).
4. Karunaweera ND, Pratlong F, Siriwardane HVYD, Ihalamulla RL, Dedet JP. Sri Lanka Cutaneous Leishmaniasis caused by Leishmania donovani zymodeme MON-37. Trans R Soc Trop Med Hyg. 2003; 97: 380-381.
5. Ranawaka RR, Abeygunasekara PH, Weerakoon HS. Correlation of clinical, parasitological and histopathological diagnosis of Cutaneous Leishmaniasis in an endemic region in Sri Lanka. Ceylon Medical Journal. 2012; 57: 149-152.
6. Chandra AR, Mahesh S. Cutaneous Leishmaniasis: a review article. Journal of Pathology of Nepal. 2017; 7: 1212-1217.
7. Sharguie KE, Hameed AF, Noaimi AA. Panniculitis is a common unrecognized histopathological feature of Cutaneous Leishmaniasis. Indian journal of pathology and microbiology. 2016; 59 (1): 16-19.
8. Eryilmaz A, Durdu M, Baba M, Bal N, Yigit F. A case with two unusual findings: Cutaneous Leishmaniasis presenting as panniculitis and pericarditis after antimony therapy. International journal of dermatology. 2010; 49 (3): 295-297.
9. Herath CHP, Ratnatunga NVI, Waduge R, Ratnayake P, Ratnatunga CN, Ramadasa S. A histopathological study of Cutaneous Leishmaniasis in Sri Lanka. Ceylon medical journal. 2010; 55 (4):106-111.
10. Dedet JP, Chatenay G. Isolation of Leishmania species from wild mammals in French Guiana. Tropical medicine and hygiene. September-October 1989; 83(5): 613-615.
11. Manamperi NH, Fernando C, Pathirana KPN, Karunaweera ND, Abeyewickreme W, De Silva MVC. Histopathological spectrum in acute and chronic Cutaneous Leishmaniasis in Sri Lanka. Proceedings of the Sri Lanka Medical Association, Anniversary Academic Sessions. 2015; 128-236.
12. Ranawaka RR, Weerakoon HS, Opathella N, Subasinha C. Leishmaniasis in North Central Province, Sri Lanka –Epidemiology and Therapeutic Response.
13. Layegh P, Moghiman T, Hosseini SAA. Children and cutaneous leishmaniasis: a clinical report and review. The journal of infection developing in developing countries. 2013; 7(8):614-617.
14. Aoun J, Habib R, Charaffeddine K, Taraif S, Loya A, Khalifeh I. Caseating Granulomas in Cutaneous Leishmaniasis. PLOS Neglected Tropical Diseases. October 2014; 8 (10), 3255.
15. Karram S, Loya A, Hamam H, Habib RH, Khalifeh I. Transepidermal elimination in cutaneous leishmaniasis: A multiregional study. Journal of cutaneous pathology. April 2012; 39(4):406-12.