Multifocal cutaneous leishmaniasis: a new clinical presentation of the disease.

Sir, Cutaneous leishmaniasis (CL) is an infection caused by protozoa belonging to the genus Leishmania (L.). The disease is transmitted by sandflies: Phlebotomus (P.) spp. and Lutzomyia spp. are the most frequently involved. Disease reservoirs are represented by dogs, mice, rats, wild rodents and, more rarely, humans. CL is very frequent in the Mediterranean Basin, especially in Sicily. L. infantum, transmitted by P. pappatasi, P. perfiliewi and P. perniciosus, is responsible for all cases observed in Sicily. From the clinical point of view, CL in the Mediterranean Basin is usually characterized by a single, polymorphous lesion located on exposed areas, in particular the face, followed by the upper limbs. In the last few years, we have observed several patients with CL characterized clinically by multiple, monomorphous, slightly inflammatory, papular or papulo-nodular lesions. Some of these lesions appeared as “twin lesions”. We believe that this presentation represents a new clinical variety of CL, which has been called “multifocal CL” by other authors (1–3). The hypothesis of a new carrier involvement is advanced.