Alterações ósseas causadas por Leishmania Amazonensis na Leishmaniose cutânea difusa (LCD)

The pathogenesis of chronic osteomyelitis is a complex process. One of the triggering factors is the presence of diverse microorganisms in bone tissue which are responsible for the lack or inefficacy of treatment. The clinical presentation of bone infection should be taken into account in the differential diagnosis of some granulomatous diseases, especially leishmaniasis which is one of the six leading endemic diseases worldwide. Objectives: The aim of the study was to evaluate the clinical, imaging and histopathological characteristics of patients with diffuse cutaneous leishmaniasis (DCL) who developed osteomyelitis caused by Leishmania amazonensis. Methods: Eight patients with DCL were studied between September 2002 and August 2004. The patients had active lesions and had not been taking any medication before admission. The bone lesions were investigated by imaging exams (three-phase bone scintigraphy and X-rays) and histopathology. Results: The mean age of the patients was 33.1 years (range: 18 to 79 years) and the duration of the disease ranged from 3 to 26 years (mean of 12 years). Relevant clinical findings included flexion deformities, joint stiffness, and shortness of fingers and toes. Three-phase bone scintigraphy showed increased fixation in the upper and lower limb extremities. Radiographic examination revealed osteopenia and tapering and resorption of the distal phalanges without joint involvement. Macrophages filled with Leishmania, bone necrosis and bone sequestration in four (50%) patients, were detected by histopathological analysis. Immunohistochemistry confirmed the positivity of the cases. Ziehl-Neelsen and Gomori-Grocott staining was negative. Conclusions: A direct relationship was observed between L. amazonensis and bone infection, characterizing chronic osteomyelitis.