Background: Cutaneous leishmaniasis (CL) is a chronic parasitic disease caused by protozoa of the genus Leishmania, primarily transmitted to humans by bites of infected female sandflies.
Case presentation: A 5-year-old girl from Damghan presented with a chronic lesion on her hand that was initially misdiagnosed as a fungal infection; however, a kDNA-based PCR assay confirmed CL despite negative direct smears. A 43-year-old man from the same region had a painful ulcerative leg lesion misdiagnosed as fungal; kDNA-based PCR confirmed Leishmania major infection, and he improved following treatment with glucantime. These cases illustrate the diagnostic challenges posed by atypical presentations and underscore the importance of molecular diagnostics for accurate detection in endemic areas.
Conclusion: Atypical CL presents diverse clinical features, especially in children, which complicate diagnosis. Increased awareness and further research are crucial to improving outcomes and refining management strategies.