Nodules on the Hand of an American Agronomist Returning From Saudi Arabia

REPORT OF A CASE A 54-year-old man presented to The Johns Hopkins Hospital, Baltimore, after completing a one-year assignment as an agricultural consultant in Saudi Arabia. He reported a one-month history of enlarging lesions on the dorsum of his left hand. There were no other cutaneous lesions or systemic complaints. Physical examination revealed two erythematous scaling nodules with focal ulceration on the dorsum of the left hand (Figs 1 and 2). Two biopsy specimens were obtained for culture and histologic evaluation. Representative hematoxylin-eosin- and Giemsastained sections of the biopsy specimen are shown in Figs 3 and 4. What is your diagnosis? DIAGNOSIS: Acute cutaneous leishmaniasis. The biopsy specimens showed nodular aggregates of histiocytes admixed with lymphocytes and numerous plasma cells. Nonencapsulated, round organisms with paranuclear rodlike kinetoplasts were identifiable filling large macrophages. DISCUSSION In the United States, leishmaniasis is most frequently reported in persons who have traveled to tropical or subtropical areas or who are from a small area in