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Dr. Joao Pereira
Dermatology, Brazil
Ulcer in healthy male
32-year-old woman, originally from Peru, otherwise healthy. Presents with a single painless ulcer on the lower leg, evolving over ~2 months. Started as a small papule, slowly enlarged, now a punched-out ulcer with raised erythematous borders and a granulomatous base. No fever, weight loss, or other systemic symptoms. He reports recent work-related travel to a rural area in South America. We took a skin scraping for microscopy – interested in thoughts on differential and next diagnostic steps.
Dr. Valentina Rojas
Infectious Diseases, Peru
This presentation is very suggestive of cutaneous leishmaniasis. A chronic, painless ulcer with raised/rolled borders after travel to an endemic rural area fits well, and in Peru L. braziliensis would be high on the list. The granulomatous base and absence of systemic symptoms also make TB or deep fungal infections less likely, though they should still be excluded with appropriate tests.
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