Cutaneous leishmaniasis: A case report of a diagnostic dilemma

Cutaneous leishmaniasis (CL) is the most prevalent clinical form of leishmaniasis and is caused by vector-borne protozoan parasite. Variation in diagnostic accuracy exists. A 54-year-old female farmer by occupation presented with lesion over right thigh for 8 months. Lesion evolved over period of 2-3 months and progressed to form ulcer with surrounding redness. On examination, solitary plaque with crateriform ulcer 3 * 2 cm in size roughly oval in shape was present. Ulcer floor was moist, smooth shiny with serous discharge, and well-defined raised erythematous margin was present. Biopsy was done which showed features suggestive of lupus vulgaris, for which anti-tubercular treatment (ATT) was started. There was persistence of ulcer despite 4 months of ATT, for which diagnosis was reconsidered and fine-needle aspiration cytology (FNAC) was performed. FNAC showed numerous intra- and extracellular amastigotes suggestive of leishmaniasis which was treated with complete disappearance of ulcer over 4 months.