A 30 year old mnan, who lived in an area endemic for leishmaniasis, was evaluated for an nontender ulcer present for 3 weeks on his right arm. A smear obtained from the ulcer showed leishman bodies. He failed to respond to topical and oral antibiotic therapy, but the lesion eventually healed with an acceptable scar. In acute leishmaniasis lesions last 2 years or less. Although a single lesion is the norm, multiple lesions occur occasionally and result from multiple bites by the sandfly. The original papules grow into nodules that eventually ulcerate and heal with atrophic scars. Old World cutaneous leishmaniasis, caused by L. tropica, is endemic to the Middle East, Central Asia, India, North Africa, and European countries bordering on the Mediterranean Sea. Infection is limited to the skin and is transmitted by sandflies of the genus Phlebotomus. The incubation period varies from weeks to months, and the course of the skin lesions varies with the host response.
