A rare case of lupoid leishmaniasis defying diagnosis for a decade.

Cutaneous leishmaniasis is a common disease affecting millions in endemic areas worldwide. We present a case of lupoid leishmaniasis, a rare variant of cutaneous leishmaniasis, which clinically mimicked sarcoidosis and/or granulomatous rosacea for ten years until ultimate diagnosis. An 82-year-old U.S. citizen with an extensive travel history presented with a ten-year history of facial plaques on the cheeks and was previously diagnosed and treated as sarcoidosis. Multiple biopsies (previously and at presentation) revealed tuberculoid granulomas with negative special stains for microrganisms and negative sterile tissue cultures for AFB, bacteria, and fungal organisms. A diagnosis of granulomatous rosacea was rendered and multiple medical therapies were attempted, none with sustained improvement. Repeat biopsy of a new lesion revealed intracellular organisms consistent with leishmaniasis, which was confirmed by PCR. Lupoid leishmaniasis is a rare presentation of cutaneous leishmaniasis including facial plaques that can mimic granulomatous diseases affecting the face including sarcoidosis and granulomatous rosacea. Cutaneous leishmaniasis can sometimes be challenging to diagnose through standard histopathologic examination; IHC for CD1a can be used to augment tissue-based examination and PCR should be sent early in cases with sufficient concern. This article is protected by copyright. All rights reserved.