A differential to consider in a case of non-healing skin lesion

Abstract

DESCRIPTIONWe report a case of a 5-year-old Asian boy with an 8-month history of non-healing lesions on the left side of cheek (figure 1).It started as a non-tender red papule which increased to a pea-sized nodule over a period of few weeks. The lesion persisted for over 6 months and was oozing pus intermittently. At the same time two other erythematous papules appeared under the chin.He had travelled to Pakistan a year before the lesions appeared. His family members did not have tuberculosis.A punch biopsy of the lesion revealed a noncaseating granuloma (figure 2). Stain and cultures for bacteria, acid-fast bacilli and fungi were negative. The Mantoux test was negative and the chest radiograph was normal. His renal, liver function, C reactive protein and erythrocyte sedimentation rate were normal. Serum immunoglobulins and lymphocyte subsets were normal. Leishmania donovani DNA complex was detected on PCR and confirmed a diagnosis of cutaneous Leishmaniasis. Ultrasound of the neck and abdomen did not show any lymphadenopathy or hepatosplenomegaly. He responded well to oral fluconazole (10 mg/kg) treatment for 2 months.Cutaneous leishmaniasis is a parasitic skin infection caused by Leishmania species, which is transmitted by sandfly bites.