AMERICAN CUTANEOUS LEISHMANIASIS AND CUTANEOUS MYIASIS: CONVERGENCE OF TWO TROPICAL DISEASES

Introduction: American Cutaneous Leishmaniasis (ACL) is an infectious disease caused by protozoa of the genus Leishmania, transmitted by the bite of infected sand flies. It manifests mainly as ulcerated skin and/or mucosal lesions and rarely presents secondary infections. Myiasis is an infection caused by dipteran larvae in human or animal tissues, generally associated with poor hygiene conditions, exposed wounds, and social vulnerability. The coexistence of these two conditions in the same patient is rare, but represents a clinical challenge in diagnosis and treatment. This report aims to discuss a case seen at a specialized infectious diseases service, exploring possible predisposing factors, clinical implications, and management strategies for the association between ACL and myiasis. This case is part of a cohort approved by the HSJ ethics committee (CAAE: 52811521.7.0000.5044). Case Description: A 34-year-old previously healthy woman, born in Fortaleza, Ceará, and from Guaramiranga, Ceará, was admitted with ulcerated skin lesions. She initially developed erythematous papules on her back, which progressed to exudative ulcers. Physical examination revealed ulcers with raised borders and honey-colored crusts on the back, feet, and left heel, some with mobile larvae and others with purulent secretion. Lesion biopsy showed epithelial acanthosis and an inflammatory infiltrate. The imprint technique identified structures suggestive of Leishmania sp. amastigotes. During evaluation of ulcers on the right knee and right foot, larvae of Cochliomyia macellaria (n=38) were identified and manually removed under lidocaine anesthesia, and ivermectin 200 mcg/kg/day was administered for 2 days. Treatment was carried out with meglumine antimoniate (Glucantime®) 20 mg/kg/day intravenously for 30 days, with progressive improvement of lesions and healing. Comments: ACL typically presents as cutaneous ulcers with a clean, dry necrotic center, raised borders, and no secondary infection. Rare cases of ACL associated with myiasis, with larvae present in the lesions, have been described in the literature, generally in contexts of alcoholism, social vulnerability, and local trauma. Myiasis can alter the typical appearance of the cutaneous lesion, making the differential diagnosis with other dermatoses, such as sporotrichosis, more difficult. Therefore, it is essential that healthcare professionals remain alert to this possible complication.