A case of granulomatous dermatitis: cutaneous leishmaniasis

A case is reported of a 75-year-old woman, with a past clinical history of granuloma annulare, who developed groups of papulonodular skin lesions on the trunk and face six weeks after returning from a trip to the Mediterranean. The initial biopsy showed a granulomatous dermatitis which was considered consistent with the sarcoidal variant of granuloma annulare, and the lesions were treated with topical and intralesional steroid. A second biopsy performed four months later revealed large numbers of histiocytes containing diagnostic Leishman bodies. It is not clear whether the first biopsy was from a chronic lesion and the second from an acute lesion, or whether local steroid treatment enhanced proliferation of organisms and made a definitive diagnosis possible on the second biopsy.