NECROTIZING AND SUPPURATIVE LYMPHADENITIS IN LEISHMANIA-MAJOR INFECTIONS

The pathology of lymph nodes and subcutaneous nodules in 6 patients wi th cutaneous leishmaniasis (Oriental sore) due to Leishmania major is described in this paper. In 3 patients enlarged epitrochlear lymph nod es were found to be associated with primary skin lesions in the forear m. The lymph node in one patient showed a necrotizing granulomatous re action that simulated tuberculous lymphadenitis. Leishmania parasites were, however, found in sections of the node, and staining for mycobac teria was negative. The second patient presented with an abscess and a discharging sinus in the epitrochlear region. Parasites were found in smears of the pus and cultures for bacteria were negative. The lesion healed with antimonial therapy. In the third patient the lesion resem bled cat-scratch disease and showed stellate abscesses and granulomas. Leishmania parasites were also identified in the sections. Sections o f a subcutaneous nodule from the fourth patient showed a necrotizing g ranuloma. The lesion healed spontaneously and the patient became leish manin-positive. In two other patients fine needle aspiration of the su bcutaneous nodules showed parasites, granuloma and necrosis. We conclu ded that L. major disseminates from the primary cutaneous lesion via t he lymphatics to the subcutaneous tissues and the regional lymph nodes . The subcutaneous nodules and lymphadenopathy may persist long after the primary lesion had healed. The primary lesion is sometimes inconsp icuous. Necrotizing and suppurative lymphadenitis due to L. major have to be distinguished from other causes of necrosis and suppuration suc h as tuberculosis and cat-scratch disease.