This twenty-year-old man traveled from Luanda, the capital city, because he heard we have a dermatologist. While this is not true, I have special interest in tropical diseases, and I was impressed with his account: numerous painful leg ulcers that persist in spite of antibiotic treatments. His lesions bear resemblance with leshmainasis – a protozoal disease transmitted to humans by sand flu bites. Additional clue: this patient enjoys the Angolan beaches. In addition to mucocutaneous disease, Leishmania protozoa can also cause visceral disease (Kala-azar) with fever, weight loss, hepatosplenomegally, and anemia. Left untreated, visceral leishmaniasis is usually fatal within months.
Diagnosis is made by serologic tests or by identification of the organism from liver, bone marrow, lymph nodes, or the margin of cutaneous lesions. Unfortunately, we have no such diagnostic capabilities at CEML Hospital. Rather, I embarked on a presumptive trial of therapy, prescribing for him the oral medication miltefosine, He’ll return in two weeks for assessment of whether or not his treatment is effective. Stay tuned for a real-time tropical dermatology update!