{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,28]],"date-time":"2025-10-28T10:28:14Z","timestamp":1761647294703},"reference-count":23,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2004,7,2]],"date-time":"2004-07-02T00:00:00Z","timestamp":1088726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acad Dermatol Venereol"],"published-print":{"date-parts":[[2004,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p>Cutaneous leishmaniasis is an endemic protozoan infection in Sardinia, one of the major islands of the Mediterranean Basin. The main causative strain in this country is <jats:italic>Leishmania infantum<\/jats:italic>, which rarely involves mucocutaneous areas, but has the potential to cause visceral leishmaniasis. An atypical leishmaniasis involving the inferior lip of a 57\u2010year\u2010old female with Down's syndrome was observed at the Dermatology Department of Cagliari (italy). The diagnosis was mainly based upon histopathological examination, revealing intra\u2010 and extra\u2010cellular leishmania amastigotes. The leishmania infantum zymodeme MON\u2010111 was identified by isoenzymatic characterization. Laboratory investigations revealed a normal complete blood count and biochemistry profile, except for an inverted CD4\/CD8 ratio. Treatment with meglumine antimoniate 60\u00a0mg\/kg\/day (Glucantime\u00ae) intramuscularly for 15\u00a0days, followed by intralesional administration 1\u00a0ml weekly for 4\u00a0weeks led to complete recovery. No relapses were observed at 6\u2010month follow\u2010up. The unusual localization is likely to be a reflection of the uncommon site of inoculation of the protozoa, transmitted by bites from flying vectors. Nevertheless, the presence of Down's syndrome in our patient may have contributed to the atypical presentation by traumatic exacerbation of the lesion, due to repeated auto\u2010induced microtraumas of the inferior lip accompanied by subclinical immunodeficiency. In fact, the specific immune response to <jats:italic>Leishmania<\/jats:italic> infection depends on a host\u2010cell\u2010mediated immune response, reported as defective in Down's syndrome patients. Differential diagnosis and early detection of the infection are necessary in order to start effective treatment and prevent more serious complications.<\/jats:p>","DOI":"10.1111\/j.1468-3083.2004.00987.x","type":"journal-article","created":{"date-parts":[[2004,8,20]],"date-time":"2004-08-20T17:14:24Z","timestamp":1093022064000},"page":"599-602","source":"Crossref","is-referenced-by-count":18,"title":["Leishmaniasis of the lip in a patient with Down's syndrome"],"prefix":"10.1111","volume":"18","author":[{"given":"C","family":"Ferreli","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L","family":"Atzori","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Zucca","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P","family":"Pistis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"N","family":"Aste","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2004,7,2]]},"reference":[{"key":"e_1_2_4_2_2","first-page":"1251","volume-title":"Textbook of Dermatology","author":"Bryceson AD","year":"1992"},{"key":"e_1_2_4_3_2","first-page":"262","article-title":"Leishmaniasis in Sardinia. 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