A 66-year-old man presented with 2 asymptomatic ulcerations on the right cheek ( Figure 1 ). These began as enlarging papules that ulcerated 2 weeks later. He had been treated for leishmaniasis a year previously, with an ulcer in the same location. Diagnosis had been made by skin biopsy and polymerase chain reaction, identifying Leishmania braziliensis . At that time, he was given intramuscular meglumine antimoniate; his lesions had healed completely within 1 month.
Figure 1 .
Two ulcerations on the right cheek, overlying scar from previous infection.
Leishmaniasis recidivans (LR) is a rare presentation of localized cutaneous leishmaniasis, recurring at the site of a previously healed ulcer [ 1 ] , as in this case. It typically affects the face, often the cheek. Leishmania braziliensis is one of the species linked to New World LR. While the pathogenesis of LR is not known, risk factors include parasite resistance and incomplete treatment. Resistance to antimonials is increasingly a concern in some regions [ 2 ] .
- Infiltrated leishmaniasis recidivans cutis on the face: a rare clinical presentation Masood S, Naveed S, Alvi RU. Trop Doct.2012;42(2):120-121. CrossRef
- Drug resistance and treatment failure in leishmaniasis: a 21st century challenge Ponte-Sucre A, Gamarro F, Dujardin JC, et al. PLoS Negl Trop Dis.2017;11(12):e0006052. CrossRef