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An Epidemic Outbreak of Cutaneous Leishmaniasis Presenting as Suppurative Folliculitis: A Study of 6 Cases

Fernandez-Flores, Angel MD, PhD*; Valerio, Lluís MD, PhD; Carrato, Cristina MD; Hernández-Gallego, Alba MD; Fernández-Figueras, Maria Teresa MD, PhD

American Journal of Dermatopathology: May 2017 - Volume 39 - Issue 5 - p 363–366
doi: 10.1097/DAD.0000000000000742
Original Study

Abstract: Folliculitis is defined as the inflammation of the follicles. The most common cause of folliculitis is infection. Here, we report an unusual cause of suppurative infundibulitis—which had not yet been described in the literature—due to Leishmania infection, and exemplified by 6 cases that occurred in the setting of an epidemic outbreak. The 6 individuals were immigrants from Morocco. Most of them were men (4 men and 2 women), and most of them were less than 30 years old (apart from one 40-year-old woman). In all cases, a cutaneous biopsy was performed. There was a granulomatous folliculitis with suppurative granulomas in all the cases. All cases showed prominence of plasma cells in the inflammatory infiltrate, and leishmanias were found in all cases. They were mainly seen in the abscessified central areas. The amount of organisms varied from a few to a moderate amount. They were stained by the anti-CD1a antibody (Novocastra) and by a polyclonal homemade anti–leishmania antibody. In addition, in 1 case, microbiological culture was performed, and Leishmania major was demonstrated as the causative agent of the infection.

*Department of Cellular Pathology, Hospital El Bierzo, Ponferrada, Spain;

Department of Internal Medicine, North Metropolitan International Health Programme (PROSICS), Universitat Autònoma de Barcelona, Barcelona, Spain; and

Department of Pathology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.

Reprints: Angel Fernandez-Flores, MD, PhD, Servicio de Anatomía Patologica, Hospital El Bierzo, Medicos sin Fronteras 7, Ponferrada 24411, Spain (e-mail: dermatopathonline@gmail.com).

The authors declare no conflicts of interest.

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