A case of lupoid leishmaniasis: NEJM case report
A 52-year-old woman from southern Tunisia presented with a 2-year history of an asymptomatic, thick, reddish plaque on her right ear. The lesion began as multiple erythematous papules that later coalesced to form an infiltrated plaque covering a large part of the auricle (Panel A).

Histopathological examination (hematoxylin and eosin stain) revealed epithelioid granulomas suggestive of leishmaniasis, tuberculosis, or sarcoidosis (Panel B). Leishmania amastigotes were not found in smears taken from the lesion, and cultures were negative. A smear and culture for acid-fast bacilli were also negative.

A polymerase-chain-reaction (PCR) assay performed on a second biopsy specimen was positive for leishmania, but the species was not specified. There was a modest response to antileishmanial therapy. Cutaneous leishmaniasis is endemic in Tunisia, particularly in the central and northern parts of the country.

Major takeaway:-
- Lupoid leishmaniasis is an uncommon form of chronic cutaneous leishmaniasis associated with Leishmania tropica in Africa, Europe, and Asia.

- Histologic features include well-organized epithelioid granulomas surrounded by lymphocytes.

- Leishmania amastigotes are frequently absent on microscopy, culture for leishmaniasis is often negative, and PCR assay is typically required for diagnosis.

Source: https://www.nejm.org/doi/full/10.1056/NEJMicm0708175
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