A 15 year old girl of Peruvian origin presents with a 3 month history of a slowly enlarging erythematous plaque extending over her nose and left cheek. The lesion started as a small, asymptomatic papule which slowly increased in size. Her medical and surgical histories are unremarkable; her family history is significant for Discoid Lupus Erythematosus in her mother. She spent her summer vacation with her grandmother in Peru and returned home 1 month prior to the onset of symptoms.
WBC: 9600/mm3 (4000-11000) N: 55% (50-70) L: 35% (20-40) Hb: 13.2 g/dL (11.5-15.5) Platelets: 220,000 (150,000-400,000)
The skin scrapings are negative for Leishmania amastigotes.
There is a diffuse dermal infiltrate predominantly consisting of macrophages. Numerous intracellular amastigotes are present.