A woman in her 50s experienced a rare congenital anomaly in her left buttock that was ‘reawakened’ by a parasitic infection. This case might be the first of its kind ever recorded.
For about two years, the woman endured a painful sore on her left buttock that required regular fluid drainage. Two decades earlier, she had a similar lesion nearby, which healed on its own, leaving a small scar. However, this new sore did not heal.
Upon seeking medical advice, doctors discovered the wound was infected by parasites. Leishmaniasis, a destructive parasitic infection, is transmitted to humans through the bites of infected sand flies, often leading to disfiguring wounds.
While most immune systems can manage and eliminate the infection, in this case, the patient had a vulnerable area in her skin. The case study noted that Leishmania parasites had transformed a congenital tract, which had been “clinically silent for decades,” into a draining lesion during her adulthood.
A congenital tract like this results from a developmental issue during pregnancy, where the overlying skin and neural tube, destined to become the brain and spinal cord, may not separate and close completely. This rare condition can create a small cavity beneath the skin that may resemble a scaly dimple.
Due to the higher risk of infection, such hidden channels are often surgically removed after birth.
However, they can be easily overlooked. Congenital dermal sinuses typically form near the spine. Although a dermal sinus on the lateral buttock has been reported before, it remains rare.
This recent case report might be the first to document leishmaniasis within a dermal sinus of the buttock. Parasites responsible for the infection excel at targeting vulnerable spots, thriving in burns, chronic wounds, and other compromised skin areas. They can also persist in scars and healed lesions.
Skin infections usually resolve spontaneously within two months to over a year after symptoms appear. However, a more severe form, visceral leishmaniasis, can cause fever, weight loss, and organ problems, and can even be fatal.
Leishmaniasis is recognized by the World Health Organization as a neglected tropical disease. Worldwide, more than a million people are infected by Leishmania parasites annually, not just in developing nations where HIV can increase vulnerability.
Fortunately, the woman in this case study suffered only a cutaneous infection and had access to medical care. After receiving medication for the infection, she underwent surgery. Her doctors found that the dermal sinus was not connected to her spinal cord or other vital organs, so it was safely removed.
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The medical team involved in her case published her story, with her consent, to increase “awareness of such rare presentations,” particularly in regions where Leishmania parasites are common.
The case study is available in BMJ Case Reports.
