Histologic examination revealed a dense dermal infiltrate composed predominantly of histiocytes and lymphocytes with scattered plasma cells forming, in areas, an ill-defined granulomatous component. Within histiocytes, there were occasional intracytoplasmic 2- to 4-µm organisms consistent with Leishmania species (Figure 3). A computed tomographic scan revealed a left lower thoracic lymphatic cord and a 2.5-cm left inguinal lymph node. Culture on Novy-MacNeal-Nicolle medium from the Centers for Disease Control and Prevention confirmed the species as Leishmania viannia panamensis (formerly known as Leishmania braziliensis panamensis).
Rash With Regional Lymphadenopathy—Diagnosis. Arch Dermatol. 2003;139(8):1075-1080. doi:10.1001/archderm.139.8.1075-a