A 45-year-old man with reactivation of previously existing and subsiding cutaneous leishmaniasis on his wrist and lower leg (shin) after renal transplantation was admitted to our dermatology service on March 2008. He presented to us with two huge tumoral and cauliflower-like lesions. Skin smear and histopathology of skin showed leishman bodies and confirmed the diagnosis. After renal transplantation, he received cyclosporine plus prednisolone to induce immunosuppression and reduce the probability of transplant rejection. After immunosuppressive therapy, reactivation of cutaneous leishmaniasis with the above presentation took place. The patient responded to 800？mg/day intravenous sodium stibogluconate for 3 weeks plus local cryotherapy. Systemic plus local therapy along with reducing the doses of immunosuppressive drugs led to improvement of lesions. Reactivation of leishmaniasis after immunosuppression has been rarely reported. 1. Introduction Cutaneous leishmaniasis (CL) is caused by a parasite from the genus Leishmania infection and is transmitted to humans by (female) sand flies bite [1]. In general, reactivation of CL occurs due to immunosuppression. Environmental factor and aging may also lead to reactivation of CL [2]. Herein, we present a patient with reactivation of CL after renal transplantation and immunosuppressive therapy who responded to a combination of intravenous (IV) sodium stibogluconate plus local therapy and reducing doses of immunosuppressive drugs. 2. Case Report A 45-year-old Iranian man with renal transplant and with two tumoral lesions was admitted to our dermatology ward on March 2008. The patient was suffering from chronic renal failure due to diabetes (non-insulin-dependent diabetes mellitus, NIDDM) for several years before this admission. The patient developed small popular lesion (2 × 5 millimeter) on his left wrist and right leg (shin) after traveling to an endemic leishmaniasis area (Natanz in Isfahan province, Iran) in April 2006. The diagnosis of CL was confirmed by a positive direct smear for leishman bodies. As the lesions were small, they remained untreated to obtain immunity for the patient. Due to chronic renal failure, renal transplantation was performed on the patient in August 2007. After transplantation, he received prednisolone tablets 50？mg/day and cyclosporine 7.5？mg/kg daily (equivalent to 600？mg for an 80？kg patient). Several weeks after renal transplantation and immunosuppressive therapy, these small popular lesions became large cauliflower-like and tumoral lesions measured 3 × 4 × 5？cm on his left wrist
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