Leishmaniasis Recidiva Cutis and Its Topical Treatment in Ecuador

© 2013 Japanese Society of Tropical Medicine 2013 This is an open ac ess article distributed under the terms of the Cre tive Commons Attribution Licens , which per its unrestric ed use, di tribution, and r production in any medium, provi d the original work is prop rly c ted. A sev n-y r-ol girl pre en ed to he Departm nt of Tropical Medicine, Biomedical Research Center, Central University of Ecuador, with four small crusted papules in the periphery of a large central scar on her left cheek. A primary lesion had appeared a year before as a painless but itchy mosquito-bite-like papule that later ulcerated and healed without treatment in approximately six months. However, four months later four small papules appeared on the border of the scar (Panel A). She received intramuscular pentavalent antimonial (Glucantime) for 15 consecutive days, but the lesions showed no improvement. Skin smears taken from one of the crusted papules and stained with DiffQuik solutions I-III (Seamens Healthcare Diagnostics Inc., Newark, DE, USA) showed abundant Leishmania amastigotes. The parasite was identified by polymerase chain reaction (PCR) as belonging to Leishmania (Viannia) guyanensis. Cutaneous leishmaniasis that relapses and manifests in small crusted or ulcerated papules is called lupoid, relapsing, or chronic cutaneous leishmaniasis in the Old World or leishmaniasis recidiva cutis (LRC) in the New World. Since this clinical form is a very rare case of American tegumentary leishmaniasis, it is worth imaging the un-