Case presentation A 19-year-old boy presented to the dermatology clinic with a 3-month history of an enlarging ulcer on his right hand and multiple tender subcutaneous nodules on the right forearm and elbow. Five months earlier, he had traveled to Ecuador and worked on an organic produce farm. Physical examination and workup On physical examination, the ulcer measured 3 cm in diameter and was tender with a firm border. A punch-biopsy specimen of the edge of the ulcer showed a dense infiltrate of lymphocytes and histiocytes.
Treatment Treatment with oral miltefosine (at a dose of 50 mg three times daily for 28 days) was initiated. What is your most likely diagnosis for this patient? Syphilitic gumma Cutaneous leishmaniasis Basal-cell carcinoma Tinea manuum Tropical pyoderma *This Case Challenge is from the Editorial Team of Docplexus and is meant for educational purposes only.…
