The patient was an 80-year old man. His relevant past history included long-standing rheumatoid arthritis treated with methotrexate. He consulted for a pruritic lesion that had arisen 2 years earlier in the intergluteal fold and that had deteriorated in the previous months. The lesion had been treated with intermittent courses of topical and oral corticosteroids, with no improvement. Physical examination revealed an infiltrated lichenified erythematous plaque that affected the whole of the intergluteal fold (Fig. 1). Skin biopsy was reported as leishmaniasis. With this diagnosis, and after excluding systemic involvement, treatment was started with intralesional meglumine antimonate (Glucantime), 2.5mL, with dose reduction as lesion size decreased. After 8 weekly injections, the patient was asymptomatic. Polymerase chain reaction on a new biopsy was negative for Leishmania, guaranteeing resolution of the condition.

Figure 1

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Leishmaniasis is a group of diseases caused by protozoa of the genus Leishmania. It is transmitted to humans by the bite of female mosquitoes of the genus Phlebotomus. Clinical presentation is very variable, from cutaneous forms with a single lesion (oriental sore), to visceral systemic forms and kala-azar. The prognosis and treatment depend on the form of presentation.