Fish tank granuloma, an emerging skin disease in Iran mimicking Cutaneous Leishmaniasis

Background: Mashhad, the center of Khorasan-e-Razavi Province in Iran, is an endemic city for a parasitic skin disease called CutaneousLeishmaniasis (CL). Fish tank granuloma (FTG), is also a skin disease cause by a free-living and fish pathogen Mycobacterium, named Mycobacterium marinum . Clinical presentation of FTG is very similar to CL. Therefore, it is usually misdiagnosed with CL. The aim of this study was to identify misdiagnosed lesions of FTG in patients who referred to Parasitology laboratory, Imam Reza Hospital, Mashhad, in order to be examined for CL.Materials/methods: During April 2015 to March 2016, more than 100 patients clinically diagnosed as CL, but their Giemsa stained smears did not approve CL, were included in this study. Ziehl-Neelsen staining performed to identify acid-fast Mycobacterium. Simoultaneously, culture on Löwenstein-Jensen medium was performed. Besides, skin lesion samples were also obtained and kept on DNA banking cards to do PCR.Results:Among 100 individuals with suspected skin lesions to CL; 29 cases have been diagnosed as FTG by PCR. . About 97% of FTG lesions were observed on fingers of hand and forearm. All of the patients had previous story of manipulating fish or were in contact with aquarium water including. Lymph adenopathy and lymphangitis were commonly observed in most of the patients. All of the patients were cured by common anti mycobacterial medicines. Relapse and resistance was not observed.Conclusion: FTG is an emerging disease mimicking cutaneous leishmaniasis or sporotrichosis. Obtaining a perfect case history from patients with previous history of swimming in fresh water or contact with aquarium fish is recommended. A molecular diagnosis is recommended at least for cases that obtain negative result by conventional methods.

کلیدواژه ها:

cutaneous leishmaniasis ، Fish tank granuloma