William Hao Syuen Ng¹, Tommy Brennan²

¹Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, Australia; ²Pathology Queensland, Metro South Health, Brisbane, QLD, Australia
 

A 62-year-old Afghani expatriate was reviewed in outpatient Infectious Disease and Dermatology clinics for rash on his right wrist. 6 years prior, when residing in Pakistan he was diagnosed with cutaneous leishmaniasis at a similar region and was treated with intralesional meglumine antimonate. Biopsies of the lesion showed granulomatous inflammation, lichenoid reaction pattern but Leishmaniasis PCR was negative.

 

Leishmaniasis is not endemic to Australia but cases are prevalent¹. Diagnosis can be challenging due to the non-specific nature of its clinical and radiological features². Histologic diagnosis can be achieved through amastigote visualization however this may not be present within the sample obtained. Granulomatous inflammation is associated with this condition however is non-specific. Culture for leishmaniasis is possible and is frequently performed, however PCR testing has been found to be a superiorly sensitive test. However, results rely on appropriate specimen collection with potential false negatives being a prevalent issue. Communication between clinicians and Pathologists is critical in this context, to obtain appropriate specimens and to facilitate appropriate processing. 

 

This case underscores the diagnostic challenges of leishmaniasis, particularly in a non-endemic region like Australia, and highlights the essential role of pathology and the need for collaboration with proceduralists in establishing a specific diagnosis.

 

References:

¹Roberts T, Barratt J, Sandaradura I, et al. Molecular epidemiology of imported cases of leishmaniasis in Australia from 2008 to 2014. PLoS One. 2015;10(3):e0119212. Published 2015 Mar 3. doi:10.1371/journal.pone.0119212

²Ea V, Papa B, Goldberg R. A case of visceral leishmaniasis masquerading as autoimmune hepatitis. Med J Aust. 2024;221(6):299-301. doi:10.5694/mja2.52412

³Australian-Indian Partnership to Eliminate Visceral Leishmaniasis: Case Study from the Australia-India Strategic Research Fund. Australian Government Department of Industry, Science and Resources. Published 4 April 2022. Accessed November 28, 2024. https://www.industry.gov.au/news/australian-indian-partnership-eliminate-visceral-leishmaniasis