Cutaneous leishmaniasis in a child from Dolpa, Nepal: a case report

Abstract

Cutaneous leishmaniasis (CL) is a neglected tropical disease (NTD) that is endemic in South Asia. It presents as chronic ulcers. Complications of the disease might be due to the difficulty in diagnosing CL, because of the presence of lesions similar to those of other skin disorders, and the lack of diagnostic resources. A four-year-old boy from Dolpa, Nepal presented to our center with a history of 10 months of painless ulcerative lesion on his right cheek. Initially the lesion was small papule which gradually enlarged over time for which topical steroid antibiotics combination was initiated. No improvement was noted on the lesion and the lesion further ulcerate. After four months, numerous Leishmania donovani bodies was revealed by fine-needle aspiration cytology (FNAC). At our center, a well-defined, round-to-oval erythematous plaque with serous exudate and yellowish-brown crust was noted on examination. The lesion was irregular with sharply demarcated margin and surrounded by erythema. The patient was then referred to Sukraraj Tropical and Infectious Disease Hospital for further anti-leishmanial therapy according to national protocol. Baseline investigations were normal. This case highlights the challenges for diagnosis of skin NTDs like CL in rural settings and essence of keeping a high index of suspicion, early FNAC/biopsy for non-healing ulcers and access to specialized care.