Intralesional Treatment of Non-American Cutaneous Leishmaniasis with Multiple Lesions.

A 44-year-old male developed five ulcerated plaques on the left upper limb (Figure 1) while in Sicily, Italy. The size of lesions varied between 1 and 2.5 cm 1 year before presentation at the Hospital for Tropical Diseases, London. There was no lymphadenopathy, lymphangitis, or subcutaneous induration. He was HIV uninfected. The ulcerated lesions had not responded to separate courses of oral clarithromycin, doxycycline, or cotrimoxazole. A skin biopsy showed granulomatous inflammation, and Leishmania donovani complex DNA was detected, confirming the diagnosis of cutaneous leishmaniasis (CL).