Cutaneous Leishmaniasis

A 28-year-old woman from Gujarat presents with multiple erythematous papules and nodules on her face, ears, and forearms that have been enlarging over the past 8 months. She denies systemic symptoms. On examination, the lesions are firm, non-tender, and some show central ulceration with a granular base. Leishmanin test is strongly positive. Histopathology shows well-formed epithelioid granulomas with few amastigotes. What is the most likely diagnosis and what does the positive leishmanin test indicate?

A 32-year-old male farmer from Rajasthan presents with a solitary nodule on the dorsum of his left hand that appeared 3 months ago. He reports the lesion started as a small papule after a sandfly bite while working in the fields at dusk. On examination, the nodule is 1.5 cm in diameter, indurated, with a central ulceration and a raised, rolled border. The base shows a granular appearance with minimal discharge. Regional lymphadenopathy is absent. Giemsa stain of the ulcer exudate shows oval, intracellular amastigotes within macrophages. What is the most likely diagnosis?

A 28-year-old woman from endemic zone in Gujarat presents with multiple erythematous, scaly plaques over the face, ears, and extensor surfaces of the limbs for 6 months. She reports that the lesions started as a single nodule 18 months ago, which ulcerated and then partially healed, but new lesions have continued to appear. On examination, the lesions show induration and scaling, with some central healing and scarring. Histopathology reveals numerous macrophages packed with Leishmania amastigotes, with a sparse lymphocytic infiltrate. Leishmanin test is negative. What is the most likely diagnosis?

A 32-year-old male farmer from Rajasthan presents with a 3-month history of a painless, indurated nodule on the dorsum of his left hand. The lesion began as a small papule at the site of a minor cut sustained while working in the fields. On examination, the nodule is 1.5 cm in diameter, with a central ulceration and a raised, indurated border. There is mild lymphadenopathy of the left axillary nodes. A biopsy specimen shows histiocytes containing amastigotes. What is the most likely diagnosis?