Cutaneous Leishmaniasis Misdiagnosed as Diabetic Foot: Case Study Calls for Increased Vigilance in Endemic Areas

Given the patient’s geographic location and the ulcer’s persistence, CL was considered, and subsequent diagnostic tests confirmed the diagnosis. A slit skin smear and skin biopsy revealed the presence of Leishmania amastigotes in the dermal histiocytic infiltrates, confirming the diagnosis of cutaneous leishmaniasis. The patient is now undergoing treatment with systemic sodium stibogluconate (pentostam), a standard therapy for CL.

Leishmaniasis, particularly CL, is a major health concern in various parts of the world, with over 1.5 million cases reported annually. While the classic form of CL is often easily diagnosed, the disease can present in unusual locations, such as the scalp, genital region, or palms and soles. Foot involvement, though rare, can be mistaken for other conditions that cause ulcerations, such as leprosy, vasculitis, or diabetic foot ulcers. The misdiagnosis of CL as diabetic foot is not uncommon, especially in endemic areas where CL is less frequently considered in differential diagnoses.

This case underscores the importance of considering CL in the differential diagnosis of chronic ulcers, especially in patients from endemic regions. Clinicians should be aware of the possibility of CL when evaluating persistent foot ulcers, particularly when typical treatments for diabetic foot fail. Routine diagnostic biopsies can be invaluable in such cases, aiding in identifying specific pathogens like Leishmania. Early diagnosis and appropriate treatment are crucial to managing CL effectively and preventing further complications.

Reference:

Al Aboud K, Al Aboud A. Cutaneous Leishmaniasis Masquerading as Diabetic Foot: A Call for Vigilance. Acta Dermatovenerol Croat. 2024 Nov;32(2):120-121. PMID: 39803740.