The case presented herein is unique because the symptoms of cutaneous leishmaniasis were misdiagnosed as a complication after an aesthetic medicine procedure.
Failure to diagnose cutaneous leishmaniasis and an incomplete patient history led to many weeks of inadequate antibiotic treatment. Many researchers note the importance of collection of a thorough medical history in medical practice [5,6,7,8].
In the present case, the doctors initially diagnosed the ulcer as a complication of laser treatment, and for this reason, the patient was treated for several weeks with general and topical antibiotics. It was not until nine months later that she was referred to the Department of Tropical and Parasitic Diseases at the University Centre for Maritime and Tropical Medicine in Gdynia, where leishmaniasis was diagnosed by PCR with the following primers: LGITSF2 and LGITSR2 . The composition of the reaction mixture was as follows: 12.5 μl of PCR Master MixPlus High GC (ready-to-use PCR mixture containing Taq DNA polymerase, PCR buffer, MgCl2 and dNTPs; A&A Biotechnology), 1 μl of each primer (concentration 10 μM) and 4 μl of DNA template, supplemented with deionized water up to 25 μl .
Proper diagnosis and treatment with antimony derivatives and cryotherapy resulted in a substantial improvement, and cure was achieved within three months. In the initial stage of cutaneous leishmaniasis, cryotherapy is very effective and safe [11, 12].
Approximately 1-10% of cases of cutaneous leishmaniasis caused by L. braziliensis in Southern and Central America may develop into the dermal-mucosal form [13,14,15]. The diagnosis of leishmaniasis is sometimes a difficult task, even for infectious disease physicians and dermatologists . The problem of incorrect diagnosis and, consequently, incorrect treatment of cutaneous leishmaniasis has been described in Poland and other European countries [16,17,18,19,20].
Because of the various clinical manifestations, physicians in the Middle East and Central and South America, where leishmaniasis is endemic, also face challenges in making a correct diagnosis and thus administering appropriate treatment. Leishmaniasis cases have been misdiagnosed as skin cancer, lupus erythematosus, mycosis fungoides and tuberculosis [1, 15, 21]. As a result of travel and migration, leishmaniasis has been reported in countries that were previously nonendemic, e.g., Thailand .