An unusual relapsing case of skin leishmaniasis.

LTB 131, a 12 year old boy, came to the clinic with a typical leishmania ulcer on his right leg (20mm in diameter with a raised rolled edge) present for 6 months. Neither giemsa stained smears nor hamster inoculation showed evidence of parasites. Histology was compatible with the clinical diagnosis. The leishmanin test (using a 30ju,g dose of protein) was negative in 1980,1981, twice in 1983 (a dose of 90jag on one occasion), 1985 and 1986. Low level titres of antileishmanial antibody (1 /2 0 1/64) were recorded by indirect immunofluorescent test on four occasions during 1980-1982. In 1980 when first seen he was advised to take 28mg Sbv/kg/day of glucantime for 15 days with 10mg/kg of nifurtimox for 30 days a formulation under trial at the time. Actually he only took 9 days treatment with the two drugs and then defaulted. However his ulcer closed 4 months later.