Image 58: This 40 year man travelled to Costa Rica and Panama for 3 weeks. One week after return to Canada he noted a small "sore" on his left ear that progessed rapidly over 3 weeks to the ulcerated and painful lesion seen here. He also had a small ulcer on his thigh. What was the genus and species of the organism found?
Tropical Disease Unit,Toronto General Hospital              case from Jay Keystone

58

Image 58; This was a Leishmania panamensis by PCR (NRCP Canada). A scraping of the lesion was leishmania-negative on culture but PCR positive (the tissue had been shipped by courier from Toronto to Montreal). PCRs were negative for L. mexicana, L. braziliensis and L. guyanensis. While chiclero's ulcers are most frequently caused by L. mexicana there are unpublished reports of chiclero-like presentations with other Leishmania species. The lesions healed well with IV Pentostam. (image below)