Cutaneous sporotrichoid leishmaniasis resistant to pentavalent antimonial therapy: complete resolution with itraconazole

Sporotrichoid leishmaniasis is a sporadic form of cutaneous leishmaniasis, a protozoal
infection, reported particularly in the Middle East. Clinically it occurs as nontender,
subcutaneous, slightly erythematous nodules, often associated with lymphangitis,
usually on exposed areas of the skin. Sometimes it occurs after treatment with a single
dose of antimonials, and in older lesions, the biopsy can be negative for amastigotes.
We report a case of cutaneous sporotrichoid leishmaniasis unresponsive to
intralesional pentavalent antimonial therapy, which completely resolved after
treatment with oral itraconazole. To our knowledge, this is only the third such case
reported. We discuss the causes of dissemination of the nodular lesions and the
negative results for amastigotes on re-biopsed lesions.