Tropical medicine rounds Dissemination of localized cutaneous leishmaniasis in an organ transplant recipient: case report and literature review Ali Zandieh 1 , MD, MPH Basira Zandieh 2 , MD, and Ladan Dastgheib 2 , MD 1 Department of Dermatology, Tehran University of Medical Sciences, Tehran, Iran, and 2 Shiraz Skin Research Center and Department of Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran Correspondence Dr Ladan Dastgheib, MD Shiraz Skin Research Center and Department of Dermatology Shiraz University of Medical Sciences Shiraz 71348-44119 Iran E-mail: dastghl@sums.ac.ir Conflicts of interest: None declared. Introduction Leishmaniasis may manifest as any of three clinically dis- tinct syndromes in the form of, respectively, cutaneous, mucocutaneous, or visceral disease. 1 Diffuse cutaneous leishmaniasis (DCL) is a rare manifestation of cutaneous leishmaniasis and is linked to cellular immunity. 2–4 It has been reported that malnutrition, immunosuppression, and human immunodeficiency virus (HIV) infection may be involved in the reactivation of latent leishmaniasis. 5–8 It is also suggested as a complication of organ transplanta- tion. 6 Reviews of organ transplant recipients with leish- maniasis show that the majority of patients have undergone renal transplantation, and most cases are iden- tified as visceral-type disease. 6,9–12 By contrast, to the best of our knowledge, few cases of localized and diffuse cuta- neous leishmaniasis have been reported after organ trans- plantation. The current study reports a male kidney recipient who presented with DCL as a manifestation of the progression and dissemination of previously acquired localized leishmaniasis. Case report A 54-year-old man from the city of Marvdasht, located in the province of Fars (in which leishmaniasis is endemic), Iran, was admitted to the dermatology ward of Faghihi Hospital (a hospital affiliated with Shiraz University) in October 2011 with multiple lesions numbering around 150 on the face, trunk, and upper extremities (Fig. 1). The subject had developed end-stage renal disease as a result of diabetes mellitus type 2 and had undergone renal transplantation in February 2011. Thereafter, he had been treated with calcitriol (0.25 lg/d) along with an immuno- suppressive regimen which consisted of mycophenolate mofetil (1 g b.i.d.), tacrolimus (2 mg/d and 1 mg at night), and prednisolone (15 mg/d), and was followed up regu- larly at an outpatient clinic. Around three months prior to transplantation, he had noticed an erythematous nodule on his left hand which gradually progressed to an erosive plaque with discharge at one month after surgery (Fig. 2). Meanwhile, multiple erosive and non-erosive nodules and plaques developed on his face, trunk, and upper extremities. Biopsy showed intense inflammatory infiltrates with leishmania amastigotes (Fig. 3). Hemato- logic and chemical tests were normal. Serologic results for the detection of anti-leishmania antibodies and a leishmanian skin test were negative. A tuberculin test showed a result of <5 mm, and venereal disease research laboratory (VDRL) titers and anti-HIV antibody were negative. Polymerase chain reaction identified the spe- cies in the skin lesions as Leishmania major. Visceral 59 ª 2013 The International Society of Dermatology International Journal of Dermatology 2013, 52, 59–62