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Background  The prevalence of Old World Cutaneous Leishmaniasis in the Mediterranean region is increasing and in Southern Europe often caused by  Leishmania infantum.  Spontaneous healing of cutaneous leishmaniasis is commonly observed, especially if caused by  L. major,  whereas  L. infantum  associated lesions have been reported with longer disease duration and decreased tendency for self-limitation, however, available information is sparse.    Case presentation  We report the case of an otherwise healthy woman from Southern Spain who presented with a seven years persistent, non-healing, painless, central ulcerated, nodular cutaneous lesion with a diameter of 2 cm of the forearm. Cutaneous leishmaniasis was diagnosed by smear and histology, showing large amounts of leishmania amastigotes in subepidermal histiocytes and extensive lymphocyte and plasma cell inflammation.  L. infantum  as the causative pathogen was confirmed by restriction fragment length polymorphism and microsatellite-PCR. Systemic or visceral involvement was excluded by negative leishmania serology and clinical presentation, relevant concomitant diseases or immunosuppression were excluded including quantification of immunoglobulin levels and lymphocyte phenotyping. Topical and systemic anti-infectious treatment options, often limited in terms of efficacy, tolerability and long lasting treatment duration, were considered. Treatment was successfully performed by surgical extraction in local anaesthesia only.    Conclusion  To our knowledge this is the longest reported duration of a  L. infantum  associated cutaneous leishmaniasis indicating a potential long lasting natural evolution of the disease in an otherwise healthy and immunocompetent patient, however, high parasite density may have reflected a lack of a  L. infantum  specific immune response. Complete surgical extraction can be successfully performed as treatment.

Non-healing old world cutaneous leishmaniasis caused by L. infantumin a patient from Spain