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CL Self-Limiting L. major — SCE Infectious Diseases MCQ

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EasyTropical & Imported InfectionsCL Self-Limiting L. majorSCE Infectious Diseases

A 30-year-old man from Sudan presents with a chronic non-healing ulcer on his forearm. He was told it was 'Delhi boil' as a child. Biopsy shows Leishmania amastigotes. The species is L. major. The lesion is 2 cm, solitary, and has been present for 8 months. What is the natural history if untreated?

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Correct answer: E — Old World cutaneous leishmaniasis caused by L. major is usually SELF-LIMITING — it heals spontaneously within 6–18 months leaving a depressed scar; treatment is offered to hasten resolution, reduce scarring, or for cosmetically/functionally sensitive locations

Old World CL (L. major, L. tropica) is generally self-limiting, healing within 6-18 months with a characteristic depressed scar. Treatment is offered for: (1) cosmetically sensitive locations (face), (2) functionally important sites (hands, joints), (3) large lesions (>4 cm), (4) multiple lesions, (5) immunocompromised patients, or (6) patient preference. L. major rarely causes mucocutaneous disease (unlike L. braziliensis in the New World). At 8 months with a small lesion, this patient may opt for watchful waiting or local treatment (cryotherapy).

Reference: WHO 2022 – Leishmaniasis; LSTMH 2019 – CL guidelines