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Cutaneous leishmaniasis is an infectious disease caused by several Leishmania species. It is transmitted to humans by the bite of the infected female phlebotomus sandfly. Today, more than 1 billion people in leishmaniasis endemic areas are at risk of infection. More than 1.5 million new cases of cutaneous leishmaniasis occur every year. On the basis of two cases, we show that cutaneous leishmaniasis is still an imported tropical disease in Germany. However, due to the increasing intercontinental travel, cases may increase. Therefore, cutaneous leishmaniasis should be considered in the differential diagnosis in patients with nonhealing wounds, ulcers, papules or nodules and the corresponding travel history.Die kutane Leishmaniasis ist eine infektiöse Erkrankung, die durch verschiedene Leishmanien-Spezies verursacht wird. Die Übertragung erfolgt durch den Stich einer weiblichen Sandmücke der Gattung Phlebotomus. Heute sind mehr als eine Milliarde Menschen in endemischen Gebieten einem Infektionsrisiko ausgesetzt, jährlich treten etwa 1,5 Mio. neue Fälle der kutanen Leishmaniasis auf. Anhand von 2 Fällen zeigen wir, dass diese in Deutschland weiterhin als bedeutende importierte Tropenerkrankung gilt. Mit der Zunahme des interkontinentalen Reiseverkehrs geht eine steigende Inzidenz der Leishmaniasis hierzulande einher. Deshalb muss die kutane Leishmaniasis bei nichtheilenden Wunden, Ulzera, Papeln oder Knoten und einer entsprechenden Reiseanamnese als Differenzialdiagnose berücksichtigt werden.

A 69-year-old man presented with a 12-month history of unilateral eczematous changes of the left nipple and areola without any signs of systemic inflammation. His main complaints were mild, intermittent itching, and occasionally local pain or burning. An external initial treatment with topical corticosteroids combined with disinfectants/antibiotics did not lead to an improvement. Triggering factors or any other conditions that could affect the diagnosis could not be detected. Histopathological examination of a biopsy from the left nipple performed at admission confirmed the suspected diagnosis of Paget disease. Radical left breast mastectomy was performed and the patient is under regular follow-up.Ein 69-jähriger Patient stellte sich mit einer 12-monatigen Anamnese von einseitigen ekzematösen Veränderungen der linken Brustwarze und des Warzenhofs ohne systemische Entzündungszeichen vor. Seine Hauptsymptome waren milder, zeitweiliger Juckreiz und gelegentlich lokale Schmerzen oder Brennen. Eine externe Erstbehandlung mit topischen Kortikosteroiden in Kombination mit Desinfektionsmitteln/Antibiotika führte zu keiner Besserung. Auslösende Faktoren oder andere Zustände, die die Diagnose beeinflussen könnten, konnten nicht eruiert werden. Die histologische Untersuchung der bei der Aufnahme durchgeführten Biopsie aus der linken Brustwarze bestätigte die Verdachtsdiagnose eines Morbus Paget. Eine radikale linke Mastektomie wurde durchgeführt, und der Patient befindet sich in regelmäßiger Nachsorge.

A 40-year-old patient with malignant melanoma pT4bN0M1a stage IV (AJCC classification 2017) was treated with the PD-1/PD-L1 antibody pembrolizumab. Three months after treatment initiation the patient developed enlarged mediastinal lymph nodes despite the partial response of the cutaneous metastases. An elective lymph node extirpation was performed. The histopathological result was consistent with a sarcoid-like reaction. Treatment was discontinued and a pulse therapy with systemic steroids led to a significant remission of the lymphadenopathy. This side effect can manifest both during PD-1/PD-L1 antibody and CTLA-4 antibody therapy and should be included in the differential diagnosis of mediastinal lymphadenopathy.

A 36-year-old homosexual man presented with a 3-week history of pin-head-sized vesicles on the lower lip followed by a tumorous infiltrate, cervical lymphadenopathy and episodic fevers. Laboratory findings included striking leukocytosis and elevated inflammatory markers. Serologically,anti-chlamydial antibodies (IgG, IgA,IgM) were present. The histological findings were compatible with a chlamydial infection; PCR examination of the tumor and lymph nodes was positive for Chlamydia trachomatis DNA. Treatment with doxycycline (2x 100 mg/daily p.o. for 3 weeks) led to rapid improvement. Lymphogranuloma venereum is a relatively rare, worldwide illness, more common in tropical and sub-tropical zones. In Germany, there are 10-50 cases reported annually but many cases go unreported. The causative organism is Chlamydia trachomatis, serotypes L1-3. The transfer occurs through skin or mucous membrane contact with an infected partner. In the advanced stage, the infection can lead to marked internal organ involvement. The special features of our case include the extragenital manifestation and the tumorous appearance of the illness which is very rarely diagnosed in Germany.