Cutaneous leishmaniasis in a Kosovan child treated with oral fluconazole

Leishmaniasis is an increasingly prevalent, major world health problem caused by infection with a protozoon which is transmitted by sandfly bites. Leishmaniasis is now endemic in 88 countries and the cutaneous forms comprise 50–75% of all new cases. In Europe it is seen in travellers returning from endemic areas and in the immigrant population. We report the case of a 2½‐year‐old Kosovan child who had cutaneous leishmaniasis (CL) despite Kosovo not being an endemic area. She was successfully treated with oral fluconazole, which is a new treatment modality for CL. A 2½‐year‐old girl presented with an 18‐month‐history of a slowly enlarging crusted lesion on the scalp. The child, a Kosovan refugee, had lived in England since the age of 3 months. The lesion had been unresponsive to topical antifungals and topical steroids prescribed by her general practitioner. On presentation the 2 cm × 3 cm papular lesion was yellow/brown, crusted and bled on minor trauma. The child was otherwise well and had no regional lymphadenopathy. A clinical diagnosis of chronic fungal or bacterial infection was made, but appropriate specimens for bacteriology and mycology were negative on microscopy and culture. A skin biopsy was taken under local anaesthetic. Light microscopy showed a dermal granuloma with multinucleate giant cells and macrophages within which were seen ‘dot‐like’ bodies consistent with Leishmania organisms (Fig. 1). A glass smear, from the surface of the lesion, was sent to the Hospital for Tropical Diseases in London and showed leishmaniasis. Subsequent electron microscopy showed a large number of amastigotes in the macrophages immediately beneath the epithelium (Fig. 2). The precise species of Leishmania was not identified. Due to recent publications on the treatment of CL with fluconazole the child was treated with oral fluconazole at 100 mg daily for 3 weeks. The lesion resolved completely leaving slight scarring.