[Erroneous tracks in the diagnosis of cutaneous and mucocutaneous leishmaniasis]

Cutaneous leishmaniasis is an uncommon finding among patients seen in Central Europe. We report on three patients with cutaneous leishmaniasis who were initially misdiagnosed. Case 1, a woman who had returned from South America, was first thought to have an ulcer due to immunosuppression. Spread of the lesions to the nasal mucosa and a cosmetically disturbing scar were partly caused by delayed diagnosis and treatment. Case 2 shows a patient who has developed red papules on both legs after a trip to Spain. The lesions were misinterpreted as a residual reaction to insect bites. In case 3, a patient who had travelled in Nicaragua, the diagnosis of leishmaniasis was delayed because of coexisting acne vulgaris. In all three patients the final diagnosis of cutaneous leishmaniasis was confirmed by culture of the parasite. The only case with positive serology was the patient with mucocutaneous involvement. Two patients were radically cured, and one patient showed a substantial improvement of the lesions. The importance of a broad history including previous travel is emphasized to avoid the fallacies of missing a rare, but important disease among people travelling to countries with endemic leishmaniasis.