Cutaneous Leishmaniasis Masquerading as Diabetic Foot: A Call for Vigilance

Area of Science:

• Dermatology
• Infectious Diseases
• Parasitology

Background:

• Cutaneous leishmaniasis (CL) is a sandfly-transmitted parasitic disease with diverse clinical presentations.
• The classical CL lesion is an ulcerated nodule, but unusual locations and forms exist.
• Foot involvement in CL is rare and often misdiagnosed due to its similarity to other ulcerative conditions.

Observation:

• A 75-year-old man from an endemic area presented with a large, chronic, necrotic foot ulcer initially diagnosed as diabetic foot.
• Despite standard wound care, the ulcer did not improve, and blood tests were normal.
• Diagnostic suspicion for CL was raised due to the patient's origin and the ulcer's characteristics.

Findings:

• Slit skin smear and skin biopsy confirmed Leishmania amastigotes in dermal infiltrates.
• The patient's foot ulcer was diagnosed as cutaneous leishmaniasis.
• Treatment with systemic sodium stibogluconate (pentostam) was initiated.

Implications:

• This case underscores the importance of considering CL in the differential diagnosis of foot ulcers, especially in endemic regions.
• Diagnostic biopsies are essential for identifying Leishmania and other specific pathogens in non-healing wounds.
• Timely and accurate diagnosis of CL is critical for appropriate management and preventing complications.