What Is Your Diagnosis? Old World Leishmaniasis

A 22-year-old man who was an army veteran presented with a persistent, tender, ulcerated plaque on the right bicep of 4 months’ duration. The lesion originally developed 6 to 8 weeks after his return from a military tour of duty in Iraq and had progressed in size, most recently becoming spontaneously ulcerated. A 2-week course of oral cephalexin resulted in no improvement.