“Chiclero’s Ulcer” Due to Leishmania mexicana in Travelers Returning from Central America: A Case Report and Review of the Literature

Cutaneous leishmaniasis (CL) due to a New World species of Leishmania is increasingly seen among returning international travelers, and most cases arise from travel to Mexico, Central and South America. We described a case of CL in a women presenting a nonhealing ulceration under her right ear with slight increase of size of the left parotid gland under the skin lesion, evolving for 4 months. In her history of travel, she reported a ten-day stay in Mexico during the Christmas vacation in the Yucatan region with only half a day walking in the tropical forest. Diagnosis of CL due to Leishmania mexicana was done via PCR detection and sequencing from swab sampling of the lesion. The patient recovered without antiparasitic treatment. Clinicians should consider diagnosing Chiclero’s ulcer in patients returning from endemic areas such as Central America and Texas who present with chronic ulceration. A noninvasive sampling is sufficient for the PCR-based diagnosis of this disease.

Primary oral tuberculosis in an immunocompetent patient

Primary tuberculosis of the tongue is very rare. The chronic ulceration is commonly misdiagnosed as a cancerous lesion. We report the case of a 44 years old immunocompetent woman who presented with a lingual chronic painful ulceration. The biopsy of the lesion showed a granulomatous inflammation, with caseous necrosis in the center. The ulceration healed after a 6 month tuberculosis treatment. Keywords: Tuberculosis; oral; immunocompetence; ulcer.

Outcome of Helal osteotomy for chronic plantar foot ulcers

Category: Diabetes Introduction/Purpose: Chronic ulceration of the forefoot is a major problem in neuropathic and diabetic feet. Foot ulceration represents a risk factor for the development of osteomyelitis and increases the risk of amputation.The purpose of this study was to evaluate the effectiveness of Helal osteotomies concerning the development of plantar foot ulcers. Methods: Eighteen patients with a mean age of 69 years (min 55 yr, max 85 yrs) suffering from chronic, refractory ulcerations of the forefoot underwent Helal osteotomies. Demographic parameters, radiologic parameters, ulcer classification, complications, ulcer recurrence and ulcer healing were documented.The ulcerations were assessed according to the Wagner Armstrong classification. Results: The mean follow up was 30 months (min 6, max 68 months). Preoperatively, there were 3 grade 1A, 1 grade 1B,5 grade 2A, 8 grade 2B and 1 grade 3B ulcers. The most common site of ulceration was the MTP 3 joint, followed by the MTP 2 joint. All ulcers recovered with a mean healing time of 5.5 weeks (min: 1 week, max. 12 weeks). One ulcer recurred due to a secondary ossification of the osteotomy. After a reosteotomy, a permanent healing of the ulcer was achieved. There were 4 complications (1 hematoma, 2 wound infections, 1 ossification), of which only the ossification required revision surgery. Conclusion: The Helal osteotomy is a safe and effective method in treating neuropathic forefoot ulcerations. The procedure allows for rapid mobilization of the patient.

Use of negative pressure wound therapy in a chronic leg wound with coexisting rheumatoid arthritis: a case study

We present a case of a 69-year-old woman with rheumatoid arthritis. The patient’s condition was managed with steroid therapy for more than 12 years. She had a coexisting infected chronic ulceration in the left leg, which was treated with negative pressure wound therapy for 52 days. Use of this therapy within the wound reduced exudate and the bacterial count, which dramatically accelerated the process of wound healing.

Pattern of Presentation of Chronic Venous Insufficiency in CVI Clinic of CMCH

Chronic venous insufficiency (CVI) is a common but often ignored problem in primary health care, sign and symptoms may ranges from mild leg heaviness or aching, dilated or unsightly veins, or troublesome odema to fibroses subcutaneous panniculitis associated with recurrent cellulitis and chronic ulceration. The prospective observational study was carried out department of surgery, Chittagong Medical College & Hospital, Chittagong. The primary purpose of the present study was to evaluate the impact of the diagnostic approach on patient of chronic venous insufficiency, varicose vein to difference primary and secondary venous insufficiency. Most common sign flebedema found in 56 (65.12%) patients was followed by dermo-hypodermatitis in 15(17.44) patients, stasis eczema in 09(10.47) patients and thrombophlebitis in 06(6.98) patients. Most frequent lower leg symptoms are heaviness 82 (95.35%) & the lowest is Throbbing 55(63.95%). The others are according to order of frequency cramps 66 (70.0%), Itching (73.26%), burning 61(70.93%), tiredness (80.23%), restless leg (82.55%), pain aching 76 (88.37%). CVI (chronic venous insufficiency) studied 04 (4.65%) were in C1, 54(62.79%) were in C2, 03(3.49%) were in C3, 11(12.79%) were in C4, 6 (6.98%) were in C5 and 8(9.30%) were in C6 according to clinical CEAP classification. Majority of patients presented with the complains of heaviness of leg and unexplained leg swelling, sex predilection is almost same for male and female but advanced stages are more common in male patients. Increasing age is associated with more advanced stage of the disease.Medicine Today 2018 Vol.30(1): 26-29