Abstract

An 80-year-old female from Kabul, Afghanistan presented with a painless erythematous lesion on the eyelid that had been present for 2 years (Figure A). Complete blood cell count, erythrocyte sedimentation rate, C-reactive protein, and blood chemistries were within normal limits. A fine needle aspiration was taken from the edge of the nodule. Giemsa stain of the sample showed numerous Leishmania donovani bodies within the macrophages (Figures B,C), characterized by a kinetoplast and double dot appearance. The diagnosis of cutaneous leishmaniasis was confirmed. The patient was treated with glucantime, a meglumine antimonate, with 20 mg/kg intramuscularly for 20 days. The differential diagnosis of eyelid leishmaniasis includes various neoplasms (such as basal cell carcinoma, squamous cell carcinoma, etc), tuberculosis, syphilis, histoplasmosis, rhinoscleroma, dacryocystitis, blepharitis, furuncle, chalazion and eczema. Given the broad differential, direct parasitological examination is the gold standard in leishmaniasis diagnosis, yet the selection of diagnostic test depends on the available resources. Using light microscopy, amastigotes (Leishman bodies) in macrophages can be identified on smears from suspected lesions using tissue biopsy, needle aspirates, or in vitro parasite culture. Immunohistochemical staining (e.g. CD1a antibodies) can aid in elucidation of amastigotes. Specimens from the ulcer base and yielded from fine needle aspiration cytology (versus scraping smears) are superior.

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