Cutaneous Leishmaniasis (Dermatology)

Medical Case Details:

Middle-aged female patient, 60 Kg weight. A resident of Pakistan recently Migrated from Afghanistan presented to me at Dermatology Opd with Painful Nodule for the past 2 months on the face, left angle of the mouth, measuring approx 5*5 cm in dimensions. It was painful, red, tender, and central ulceration, as you can see in the attached pictures. So, according to clinical presentation, I made a differential diagnosis of Cutaneous Leishmaniasis because of travel history from Afghanistan because of the sandfly, which causes Leishmaniasis to present in the Afghan region. The patient refused any insect bite, but on my clinical examination, I was sure it was Leishmaniasis, but for the patient's satisfaction and confirmation of my diagnosis, I ordered small Incisional Histopathology of the nodule and started broad-spectrum oral Antibiotic for Secondary infection and edema around the nodule. Two days later, the patient's histopathology report came back positive for cutaneous Leishmaniasis and Organism seen was Leishmania tropica, which is common among Leshmiansis Species. As that was a confirmed Case of Cutaneous Leshmiansis, so Started Injection Meglumine Antimoniate (Glucantime) one injection daily 5ml Intravenous for three weeks with a small dose of inj Glucantime 1ml in lesion after 3 days. After a week, the nodule size reduced to half, and central ulceration disappeared, as you can see in the picture. On the 20th day of injection, the nodule completely disappeared, and the skin became normal with no pain, as you can see in the picture. So why I shared this case with you all is because it was a rare case in dermatology, so you should have some idea about it.
Thanks. Best regards.
Dr. Maher Nabeel Ahmed Family Physician, General Practitioner