Images in Clinical Medicine

Cutaneous Leishmaniasis

Mahdi Malekpour, M.D., and Mohsen Esfandbod, M.D.

N Engl J Med 2010; 362:e15February 11, 2010

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A 25-year-old man presented to our clinic with a 1-year history of skin lesions on his nose and arm. Physical examination was notable for painless erythematous papules and nodules with overlying scale and crust, some of which had central ulceration (Panels A and B). The patient was from Meshkinshahr, Iran, an area in which cutaneous leishmaniasis is endemic. A biopsy specimen of the nodule on the nose revealed intracellular Leishman–Donovan bodies (amastigotes), and tissue culture together with polymerase-chain-reaction assay confirmed infection with Leishmania tropica. Leishmaniasis is transmitted by the bite of an infected sandfly. Cutaneous leishmaniasis typically begins as a painless papule that enlarges to a nodule with a central crust. The papules and nodules enlarge, may develop central ulceration, and take approximately 1 year to heal without treatment. Satellite lesions may also be present. The patient was treated successfully with injections of sodium stibogluconate. The skin lesions resolved, with minimal scarring.

Mahdi Malekpour, M.D.
Mohsen Esfandbod, M.D.
Tehran University of Medical Sciences, Tehran, Iran
sfandbod@sina.tums.ac.ir