Cutaneous Leishmaniasis in an Immunocompromised Pediatric Patient With Acute Lymphoblastic Leukemia

Leishmaniasis is a protozoan disease caused by the parasite Leishmania. It is most common in developing countries. Its clinical presentation varies depending on several factors such as patient's immunity. Cutaneous leishmaniasis is one of the main types of leishmaniasis, it is known to be a great mimicker. When seen in immunodeficient populations, such as patients with acute lymphoblastic leukemia, it may present more aggressively and its diagnosis is challenging. We present a case of a five-year-old male with a history of acute lymphoblastic leukemia undergoing chemotherapy who developed papules evolving into ulcerated nodules on his left lower extremity. An initial smear for leishmaniasis was negative, the disease evolved and spread in an ascending fashion, while efforts were made finding a diagnosis. One-month later the smear was repeated and positive for leishmaniasis. Subsequently, therapy with Meglumine antimoniate was prescribed. The lesions healed with atrophic scarring without complications. Cutaneous leishmaniasis diagnostic methods are not standardized, limitations such as interpreter's expertise and patient's immunity state may play a role in delaying the diagnosis.