Cutaneous leishmaniasis — SCE Dermatology MCQ

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HardInfectious diseaseCutaneous leishmaniasisSCE Dermatology

A 34-year-old man returns from rural Brazil with a painless enlarging ulcer on the forearm. It has a raised indurated border and a clean granulating base. He remembers insect bites, and antibacterial treatment has not helped. What is the most appropriate investigation?

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Correct answer: C — Lesional biopsy or scraping for Leishmania PCR testing

Explanation lettering: D = shown as B · E = shown as D · B = shown as E

C is correct. A chronic painless ulcer with a raised indurated border after rural exposure in Brazil is suspicious for cutaneous leishmaniasis. Diagnosis requires parasite detection from appropriate lesional material; biopsy or scraping can support microscopy, histology and PCR-based species identification. Species matters because mucosal risk and treatment vary, so specialist tropical-medicine or infectious-disease input is appropriate. Patch testing investigates allergic contact dermatitis, not an enlarging travel-associated ulcer. Dermoscopic surveillance would delay tissue diagnosis. Varicella-zoster serology does not establish the cause of a chronic localised ulcer. A bacterial swab may detect secondary colonisation but cannot exclude Leishmania and should not be the sole investigation after antibacterial failure. The key step is therefore direct lesion sampling for parasitological and molecular testing.

Reference: Journal of Travel Medicine and Infectious Disease: UK cutaneous leishmaniasis diagnosis: https://www.sciencedirect.com/science/article/abs/pii/S1477893904001231