CLINICAL 44-year-old female with a 1-month history of a quickly enlarging indurated oval slightly red lesion, centrally dimpled and warty, measuring 1 cm in diameter and raised 4-5 mm above the surrounding surface on the dorsum of the right hand. The patient had been in Belize, in Central America, 2 months earlier. There were smaller synchronous lesions on the shoulder and elbow. Punch biopsy in January 2002 showed leishmaniasis. Biopsy was followed by liquid nitrogen treatment, but the lesion recurred and enlarged. It was rebiopsied in February and consultation was obtained from Dr. Barbara Herwaldt at the CDC (assistance available free to any physician, call 770-488-7772). Dr. Herwaldt provided antimonial medications which were infiltrated through a PICC line over a 20-day period. All the lesions responded to this medication. Culture demonstrated the organism to be Leishmania mexicana.
HISTOLOGY Innumerable round to oval slightly basophilic structures within histiocytic vacuoles and between collagen fibers. The structures are GMS negative and not particularly reactive to PAS. Giemsa demonstrates diagnostic kinetoplasts within the leishmanias (amastigotes).
IMPORTANT FEATURE: REASON FOR PRESENTATION Unusual parasitic disease with clinical photos showing response to antimonial medication.

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