New World Cutaneous Leishmaniasis Treated with Intralesional Injection of Pentavalent Antimony
A 37-year-old man presented with a 3-month history of cutaneous lesions on the left postauricular area and left arm. The patient had experienced several insect bites while traveling to the Amazon region in Brazil five months ago. On physical examination, a painful and erythematous nodule with two satellite papules on the left postauricular area and a papule on the left arm were observed (). Initially, we suspected cutaneous leishmaniasis because of the appearance of the lesions and history of insect bites when he traveled to the endemic area. Then, we performed skin biopsies of the lesions. Histopathological examination revealed numerous Leishman-Donovan bodies in the cytoplasm of macrophages (). After confirming the diagnosis of New World cutaneous leishmaniasis, the patient was treated with itraconazole 200 mg/day for 7 weeks and metronidazole 1,500 mg/day for 5 weeks; however, there was no improvement. After the patient received intralesional injection of 0.1 ml of sodium stibogluconate (Pentostam®) twice a week for 4 weeks, the lesions were improved with minimal scarring. During treatment, several subcutaneous nodules developed around the lesion on the left arm. Histopathological examination of the new lesions showed chronic granulomatous inflammation and no evidence of Leishman-Donovan bodies (). After 3 months, the newly developed lesions were resolved without further treatment (), and no recurrence of the lesions has been observed to the present.