Cutaneous leishmaniasis arising in a latent dermal sinus causing a dermoscopic dilemma

Dermal sinus tracts (DST) are rare epithelial-lined anomalies, typically located along the midline and diagnosed in early life. Cutaneous leishmaniasis (CL), although endemic in many regions, rarely involves non-exposed sites or congenital structural anomalies. To our knowledge, no prior report has described CL occurring within a latent lateral DST.We present the case of a woman in her mid-50s with a chronic draining gluteal lesion whose induration and dermoscopic features mimicked a keratinising tumour. Her history revealed a previous lesion 20 years earlier, adjacent to the current lesion site and likewise characterised by chronic discharge; it had spontaneously resolved, leaving an atrophic scar. Clinical and parasitological evaluations confirmed CL, while histological examination of the excised specimen demonstrated a chronic fistulous tract, consistent with a dermal sinus tract in the appropriate clinical and surgical context, without granulomas or malignancy. Dermoscopic findings included central erosion, starburst-like structures, polymorphous vessels and white halos, evolving over time despite parasitological cure. Surgical excision revealed a blind-ended, non-communicating sinus tract with chronic inflammatory remodelling.This case illustrates how a dormant congenital anomaly may function as a localised immunocompromised cutaneous district, creating a permissive microenvironment for parasitic colonisation. It also highlights the diagnostic complexity generated by overlapping dermoscopic features. Awareness of such rare presentations is crucial in endemic areas to ensure accurate diagnosis and prompt management.