Erysipeloid cutaneous Leishmaniasis treated with the combination of metronidazole and clarithromycin

Leishmaniasis is caused by an intracellular parasite transmitted to humans by the bite of a sandfly: Phlebotomus. The disease can present in three ways: visceral, cutaneous, or mucocutaneous forms. Unusual clinical presentations of cutaneous leishmaniasis have been reported: psoriasiform, eczematiform, erysipeloid, and sporotrichoid, depending on host immune status and Leishmania subspecies. We report a case of an unusual presentation of erysipeloid cutaneous leishmaniasis treated with the combination of Metronidazole and Clarithromycin. A 67-year-old woman presented with a 2-month history of swelling of the centrofacial region, with an erythematous and edematous plaque; the episode was treated as facial erysipelas with antibiotics. In the absence of improvement, the diagnosis of cutaneous leishmaniasis in its erysipeloid form was suspected and then confirmed by a skin smear showing the presence of leishmania amastigotes. The patient was treated with metronidazole and clarithromycin for 30 days, with good progression.