Pre-ulcerative leishmaniasis mimicking chilblains in a returning traveler from Southern Europe

Cutaneous leishmaniasis (CL) is caused by protozoa of the genus Leishmania and typically manifests as multiple or single ulcers or papulo-nodular lesions. Atypical lesions are rare but can simulate a large variety of dermatological disorders.(1) A 65-year-old traveler returning from Spain and Portugal presented in January 2020 to our department with a 6-week history of acral, non-ulcerative, livid erythema on his right foot (Figure 1A). Previously, the patient had consulted three different doctors that had diagnosed a bacterial soft-tissue infection, which however did not respond to topical and systemic antibiotics.