# Iceberg phenomenon in cutaneous leishmaniasis: A sporotrichoid clue

## TL;DR

A woman with cutaneous leishmaniasis caused by Leishmania major showed unusual deep tissue involvement detected via MRI, highlighting challenges in diagnosis and treatment.

## Contribution

First MRI evidence of deep tissue involvement in sporotrichoid cutaneous leishmaniasis caused by L. major.

## Key findings

- MRI revealed deep tissue involvement in a case of sporotrichoid cutaneous leishmaniasis.
- The case highlights diagnostic and treatment challenges of atypical leishmaniasis.

## Abstract

We present a 29-year-old immunocompetent Uzbek woman with an ulcerated nodular lesion on her arm following an insect bite, caused by Leishmania major and confirmed by polymerase chain reaction (RT-PCR). The patient was initially treated with oral itraconazole and topical imiquimod. However, the disease progressed over 3 months and systemic liposomal amphotericin B was subsequently initiated.

Magnetic resonance imaging (MRI) revealed deep tissue involvement, marking the first such finding in sporotrichoid cutaneous leishmaniasis caused by L major. This case emphasises the diagnostic and treatment challenges of atypical cutaneous leishmaniasis and highlights the value of imaging techniques in assessing disease extent.