A Case of Pauasitic Ctuanuloma in which Developmental Forms of 



LeISHMANIA TKOriL'A WEltE PRESENT 

 BY 



Captain R. G. Akchibald, M.B., R.A.M.C, attached E.A. 



Pathologist and Assistant Bacteriologist 



Wellcouic Tropical Research Laboratories, Khartoum 



Balfour and Thomson' recently described two cases of non-ulcerating oriental sore 

 in which the lesions presented themselves as j)ink keloid-like growths. 



In these growths the typical parasites of oriental sore were present and the name 

 of Leishman nodules was suggested for them as a better form of nomenclature 

 for this type of lesion. A few months ago a case which, in some points, resembled 

 the cases described by Balfour and Thomson, was sent from the Khartoum Military 

 Hospital to these Laboratories for microscopical investigation. 



The history of the case was as follows : — 



Ibrahim Bachit, aged about 30, a soldier in the 5th battalion, was admitted to the 

 Khartoum Military Hospital sufi'ering from various growths on the face, arms, body and 

 legs. These growths had been in existence for a period of four months. There was 

 nothing of singular importance either in the patient's history or in that of his family. He 

 was a Nuba of good physique, with no previous history of syphilis and there was no 

 enlargement of the spleen or liver. 



Through the kindness of Captain E. .1. C. Thompson, R..\.M.C'., facilities were given 

 for the purpose of studying the various skin lesions present in tliis case. 



On examination, these skin lesions presented themselves in the form of slightly raised Appearance of 

 soft papules varying in size from 1/16 inch to ^ inch (Figs. 49 and 50). They were situated j \^ '" 

 for the most part on the arms and body, a few being present on the face and legs. One 

 or two of the papules had become pustular in nature and were covered Vjy a thin scab. 

 On the flexor aspect of the right forearm there was also present a skin lesion which 

 resembled in appearance a syphilide, and, situated behind the right external malleolus, 

 there was, in addition, a small warty growth with an irregular surface. 



According to the patient these multiple papular growths first appeared on the arm as 

 small pink spots about the size of a pin's head, steadily growing till they had reached the 

 size of a pea ; their existence was not associated with any pain or irritation. Examination 

 of them with a hand lens showed the presence of a pale pink centre over which the epidermis 

 appeared to be stretched and thinned out. On palpating the individual papules a definite 

 indurated margin could be felt ; they were freely movable over the subjacent tissues. 

 Around some of the papules there were present small pink pin-point elevations which were 

 evidently secondary growths appearing aroiind a primary one. There was no enlargement 

 of the lymphatic glands either in the neck, axilla or groin. A fine glass pipette was inserted 

 into the centre of each papule and the contents, consisting of blood, serous fluid, and a 

 cheesy material, were blown on to a slide and stained by Leishman's stain. During this 

 procedure it was quite evident that the coagulability of the blood was considerably increased. 



'■ Balfour, A., aad Thomson, D. B. (January, 1910), "Two cases of non-ulcerating Oriental Sore, better 

 termed Leishmau nodules." Traiisactions of the Society of Tropical Medicine and Hygiene. 



