Unusual clinical variants of cutaneous leishmaniasis in Pakistan

Cutaneous leishmaniasis is endemic in the Baluchistan province of Pakistan and poses a great risk to non-immune visitors to the area. The wide spectrum of clinical variants of this common disease is at times a diagnostic challenge. A total of 1709 patients with cutaneous leishmaniasis were recorded over a 1-year period. In 37 (2%) patients the lesions were very unusual, and therefore worth reporting. These included acute paronychial, chancriform, annular, palmoplantar, zosteriform and erysipeloid forms. The zosteriform and erysipeloid forms have rarely been reported previously, but to the best of our knowledge, acute paronychial, chancriform, annular and palmoplantar lesions are being reported for the first time. The morphologically unusual lesions may be attributed to an altered host response or involvement of an atypical strain of parasite in these lesions.