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Four persons with a history of exposure in areas known to be hyperendemic foci of Leishmania braziliensis later continuously resided on the altiplano in Bolivia at altitudes in excess of 3,600 meters where transmission does not occur. After periods of 11, 18, 19, and 24 years, respectively, of completely occult infection, these patients experienced onset of the characteristic mucous lesions of espundia. Generalized debilitation from other causes was common to three cases, and could have triggered this secondary manifestation of leishmaniasis.