Botón de oriente «lupus eritematoso-like» con lesiones multiples. Tratamiento con itraconazol

A 22-year-old HIV-negative, immunocompetent man presented in april 1994 with several reddish scay plaques on his face, which were suggestive of cutaneous lupus erythematosus. Histopathologic examination was consistent with cutaneous leishmaniasis, and culture was positive for Leishmania infantum. Serologic tests for Leishmania infection were positive, whereas the Montenegro reaction was negative. Several intralesional injections of Glucantime® were unsuccesful, with continued appearance of new lesions, so a therapeutical with oral Itraconazole 400 mg/day for one month, followed by 200 mg/day for two additional months, was attempted. New lesions ceased to appear following 15 days of treatment, and the preexisting ones eventually resolved. We propose i tat in patients with Leishmania-specific immune suppression, multiple cutaneous lesions are probably caused by hematogenous dissemination, systemic treatment thus being preferable in this subset of patients.