The frequency of vascular changes in the histopathology of cutaneous leishmaniasis

Introduction: Cutaneous leishmaniasis (CL) is a parasitic skin infection which can be debilitating. This study was performed to determine the vascular changes in the histopathology of CL. Methods: Thirty-seven patients with CL were included in a prospective study. A 4 mm punch biopsy was obtained from the border of the lesion. After histopathologic processing and H&E staining, it was reviewed by a pathologist. In addition, 285 cases of CL, whose biopsy files were restored at the pathology ward, during a 23 year period, were reviewed for the assessment of vascular changes. Immunoperoxidase staining for IgG and IgA was also performed on paraffin-embedded blocks. Results: Out of the 37 patients with CL, 64.7% were male and 35.3% were female. In this group, 73.5% had chronic and 26.5% had acute CL. The most common type of lesion was an ulcerated plaque. Of the total of 322 biopsy files that were reviewed, 34 (10.5%) had vascular changes in their lesions. The vascular changes included moderate to severe perivascular lymphocytic infiltration and severe perivascular lymphocytic infiltration with obstruction or narrowing of vessels with or without destruction. A few cases showed endothelial proliferation of blood vessels and one case had leukocytoclastic vasculitis. Conclusion: CL should be considered in the differential diagnosis of chronic cutaneous ulcers in endemic areas, which demonstrate vascular changes or vasculitis in their pathology. Severity of the disease may be due to the underlying intense local inflammatory reaction, manifested as lymphocytic vasculitis.