Atypical cutaneous leishmaniasis in the immunosuppressed.

A 45-year-old woman, known case of seronegative arthritis and on immunosuppressive therapy, presented with a 2-week history of a macular lesion on the left calf that became papular and eventually ulcerated. The rest of the history was otherwise unremarkable and systemic examination did not reveal any abnormalities. The lesion was repeatedly biopsied but failed to reveal Leishmania donovani bodies. Concurrent Leishmania IgG was positive but IgM was negative. Leishmania IgG confirmatory testing by ELISA was negative. A biopsy from the lesion eventually tested positive for L. donovani through PCR. The patient was treated with sodium stibogluconate together with intravenous ciprofloxacin and amoxicillin to cover the secondary cutaneous bacterial infection. This led to complete resolution of the lesion.