Track

Case Reports

Abstract

A 41-year-old man with no significant past medical history presented for excision of a symptomatic keloid. The keloid was present since injury during adolescence, with symptoms initially limited to intermittent itch and discomfort. Prior interventions included intralesional triamcinolone injections of unknown strength as well as excision with two post-operative radiation sessions. The latter directly preceded deployment to the Middle East. During deployment, over ten years ago, the patient reported pain and purulent drainage from the superior aspect of the keloid. Recurrent drainage continued over the next decade. He denied fevers or systemic symptoms. Physical examination showed a mid-sternal hyperpigmented indurated smooth plaque measuring six by three centimeters with superior focus of a 0.2 centimeter hyperkeratotic plug. Partial excision of the keloid revealed a sinus tract with subjacent mixed inflammation, granulation tissue, and background keloid. Within the mixed inflammation, many parasitized histiocytes were identified. Uniform, round organisms displayed focal intracytoplasmic rimming of the histiocytes. The organisms demonstrated positive CD1a immunostaining and Giemsa special staining. Taken together, a diagnosis of cutaneous leishmaniasis was rendered. One-week post-operative follow-up demonstrated focal dehiscence and scant serous drainage from the inferior aspect of the excision. Punch biopsy was performed and submitted as a fresh specimen. Confirmative speciation by polymerase chain reaction analysis is pending. This case emphasizes keloidal morphology as a clinical presentation of cutaneous leishmaniasis. Histopathologic examination of keloids with evolving symptoms is encouraged in patients with exposure to geographic regions at risk for neglected tropical diseases.