Abstract
Visceral leishmaniasis (VL) is a systemic disease caused by protozoa of the genus Leishmania. Although cutaneous lesions in VL are unusual, their occurrence has been increasing due to HIV co-infection. These lesions can manifest as macules, papules, plaques, nodules, and ulcers, and may affect both normal and pathologic skin. Transepidermal elimination (TEE) is an atypical form in which amastigotes are eliminated through eccrine gland ducts, suggesting eccrine epithelial tropism and a potential transmission route.
We report a case of a 47-year-old HIV-positive male with VL that presented with bullous lesions followed by erosions over the past 5 months. Initially located on his face, they posteriorly spread to his upper and lower limbs. Clinical examination revealed exulcerated lesions in the cervical area, ears, and right knee, along with hypopigmented cicatricial areas and tense bullous lesions on the left arm and hand. A skin biopsy from the knee revealed an ulcerated epidermis and the presence of amastigotes throughout the entire length of the sweat gland duct, within the cytoplasm of the epithelial cells.
TEE of Leishmania sp. through eccrine epithelial ducts is a rare phenomenon, with only a few documented cases. This striking histopathological presentation of VL with HIV co-infection highlights the importance of considering TEE as a potential manifestation of the disease, emphasizing the need for increased awareness and understanding of this rare phenomenon.