Cutaneous leishmaniasis: A case report of a diagnostic dilemma

Cutaneous leishmaniasis (CL) is the most prevalent clinical form of leishmaniasis and is caused by vector‐borne protozoan parasite. Variation in diagnostic accuracy exists. A 54‐year‐old female farmer by occupation presented with lesion over right thigh for 8 months. Lesion evolved over period of 2–3 months and progressed to form ulcer with surrounding redness. On examination, solitary plaque with crateriform ulcer 3 * 2 cm in size roughly oval in shape was present. Ulcer floor was moist, smooth shiny with serous discharge, and well‐defined raised erythematous margin was present. Biopsy was done which showed features suggestive of lupus vulgaris, for which anti‐tubercular treatment (ATT) was started. There was persistence of ulcer despite 4 months of ATT, for which diagnosis was reconsidered and fine‐needle aspiration cytology (FNAC) was performed. FNAC showed numerous intra‐ and extracellular amastigotes suggestive of leishmaniasis which was treated with complete disappearance of ulcer over 4 months.