Complicated Skin Ulcer from Misdiagnosis and Inappropriate Treatment of a Cutaneous Leishmaniasis Lesion. Case Report

Introduction: American cutaneous leishmaniasis, a sand fly transmitted neglected tropical disease caused by Leishmania spp. parasites, is endemic in most Latin-American countries.

Case report: We present a 54-year-old-woman case, showing a grade II ulcer in the left leg’s malleolar zone with a presumptive clinical diagnosis of skin neoplasia lesion. For 6 weeks this patient received antibiotic treatment after being subject to a surgical skin grafting. However, biopsies from the ulcer did not reveal neoplasia components, the lesion was unresponsive to antibiotic therapy and reject the skin grafting. The ulcer was treated with antibiotic for six additional weeks, without size reduction. Months later, we diagnosed the patient’s lesion as leishmaniasis, based on: i. positive Leishmanin skin test, ii. detection of amastigotes from the lesion and iii. positive PCR assay. Treatment with a pentavalent antimony compound was administered in a perilesional infiltration (PLI) combined with daily applications of an antimony based nanoemulsion cream. After 60 days of treatment, the ulcer was observed epithelialized with a scar.

Conclusion: Combined Sb5+-PLI-meglumine antimoniate and nanoemulsion cream, is a cost effective and safe anti leishmanial therapy option, accessible to all people, including the poorest of the poor infected with cutaneous leishmaniasis.