Iceberg phenomenon in cutaneous leishmaniasis: A sporotrichoid clue

We present a 29-year-old immunocompetent Uzbek woman with an ulcerated nodular lesion on her arm following an insect bite, caused by Leishmania major and confirmed by polymerase chain reaction (RT-PCR). The patient was initially treated with oral itraconazole and topical imiquimod. However, the disease progressed over 3 months and systemic liposomal amphotericin B was subsequently initiated. Magnetic resonance imaging (MRI) revealed deep tissue involvement, marking the first such finding in sporotrichoid cutaneous leishmaniasis caused by L major. This case emphasises the diagnostic and treatment challenges of atypical cutaneous leishmaniasis and highlights the value of imaging techniques in assessing disease extent.