A 46-year-old immigrant from Iraq presented with 3 painless, crusted and inflamed ulcerations on his hands. Axillary adenopathy was absent, and he was otherwise in good health.
Key point: The patient’s lifelong residence suggests an unusual tropical disorder. Biopsy showed innumerable parasitized histiocytes, pathognomonic for leishmaniasis. This confirmed the clinical suspicion.
Treatment: The treatment of choice remains intramuscular or intravenous administration of pentavalent antimony. However, Old World leishmaniasis often spontaneously involutes, and the preferred treatment can be quite toxic. Because the patient was asymptomatic, watchful, restraint was exercised, and the lesions all resolved without treatment in about 12 weeks.
Note: Leishmaniasis remains an important infection which can be “imported” from endemic foci, such as the Middle East.