Cutaneous Leishmaniasis in High-Altitude: A Case Report From Nepal

Leishmaniasis is a parasitic infection caused by Leishmania and spread by the bite of a sandfly, most commonly Phlebotomus. Among the three subtypes of Leishmaniasis, cutaneous leishmaniasis is the most common form. Visceral Leishmaniasis is common in Nepal whereas few cases of cutaneous leishmaniasis have been reported in migrant Nepalese population. The most common lesion seen in cutaneous leishmaniasis is papulo-nodular although other morphological lesions can also be seen. A 30 years female currently residing in Humla presented with a history of multiple non-tender nodules with central necrosis with size approximately 3 × 4 cm and 5 × 4 cm present at left lower chin and right lower eyelid respectively. Punch biopsy was done from the site of lesion which showed the presence of amastigote form of Donovan bodies, consistent with the diagnosis of Cutaneous Leishmaniasis. The patient was treated with Oral Miltefosine for 4 weeks and advised for follow-up. This case report highlights the importance of considering Cutaneous Leishmaniasis as one of the differential diagnoses with papulo-nodular lesions in non-endemic areas like Nepal.