Sporotrichoid cutaneous leishmaniasis in a traveler

A 19-year-old construction worker from Virginia who had traveled in Bolivia had sporotrichoid lesions on the left arm. Only after unsuccessful therapy for sporotrichosis was a diagnosis of cutaneous leishmaniasis considered. Biopsies revealed necrotizing granulomatous changes, and culture of the biopsy specimens grew Leishmania (Viannia) braziliensis. The sporotrichoid pattern seen in this patient is a rare but recognized presentation of cutaneous leishmaniasis, more commonly seen in American cutaneous leishmaniasis than in Old World cutaneous leishmaniasis. This case illustrates the necessity of careful and early consideration of tropical infections in the differential diagnosis of disease in a traveler.