A 67-year-old Iraqi woman presented for medical evaluation of a facial “sore.” She was visiting relatives in the United States, while the lesion enlarged.
Key point: The crusted erosion is either infectious or neoplastic, and a biopsy is required to determine the correct diagnosis. The skin biopsy showed parasitized histiocytes, typical for leishmaniasis—an infectious parasitic disease endemic to the patient’s native country.
Treatment: Although the treatment of choice is typically an intravenous or intramuscular pentavalent antimonial, azole antifungals will sometimes demonstrate efficacy, and application of intense heat (50°C) may be used as either curative or adjunctive. The patient was happy that the lesion was not malignant, and refused all intervention.
Note: Old World leishmaniasis often resolves spontaneously, so the patient’s decision to forego therapy was not totally irrational. The patient’s family subsequently informed me that the lesion did involute on its own, leaving a small residual scar.
