A 34-year-old woman, resident in the municipality of Carepa in Urabá Antioqueño, Colombia and rural worker in the villages "El Cerro" and "Remedia poor", endemic areas for leishmaniasis.
She presented with a two-month history of erythematous papules on the back of her left hand with progressive enlargement and subsequent ulceration.
She reported no other associated symptoms, nor trauma or insect bites.
He had a history of varicella at 9 years and hepatitis A and malaria by P. vivax at 10 years.
The patient was evaluated in our center, being in good general condition, with stable vital signs.
In the physical examination integrity of the nasal mucosa was found and in the skin two clean ulcerated lesions of 2 cm in diameter were found, with indurated edges, located on the back of the left hand adenocle painful proximal epich 1.5 cm.
A direct examination of the lesion revealed the presence of melanomas of Leishmania spp., confirming the diagnosis of CL.
Treatment was prescribed with meagreement i.m.
20 mg/kg/day for 20 days.
Before starting treatment, general tests (uroanalysis, liver transaminases, amylases, urea nitrogen, creatinine and blood count) were normal.
The patient was referred to her municipality of origin for supervised treatment, with adequate clinical response, without reporting side effects.
Three days later, the patient presented with cutaneous manifestations secondary to left dermatologic treatment: papular, vesicular and pustular lesions with burning sensation and local pain, initially in the right submammary region, extending to the dorsum on the
She was managed as an allergic reaction with topical corticosteroids without improvement, so she was referred to our center where the diagnosis of herpes zoster was made.
A Tzanck test was performed on a vesicular lesion that showed the presence of multinucleated giant cells, which supported the clinical diagnosis.
The patient was managed with oral antiviral therapy 800 mg five times a day for 7 days.
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Extension studies were performed: breast ultrasound, vaginal cytology, syphilis serology and HIV infection, all negative.
No control blood count was performed because it had no clinical indication.
VZV microbiological confirmation and serology were not possible.
At the six-month follow-up visit, there were no new ulcers of leishmaniasis or herpes zoster, with adequate healing of the old lesions.
