P LEISH

 A

Alright, based on what you described —
3-year-old boy, 6 weeks of ulcerated plaques with rolled borders and satellite papules on left lower leg, plus recent immigration from Venezuela with a long land journey —

This clinical picture raises some key differential diagnoses (DDX):

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DDX:

1. Cutaneous leishmaniasis

   • Very high on the list: endemic in Venezuela, classic for ulcerated plaques with rolled margins, satellite lesions.

2. Atypical mycobacterial infection (e.g., Mycobacterium marinum)

   • Environmental exposure (soil, water), papulonodular or ulcerative lesions, often after trauma.

3. Deep fungal infection

   • (e.g., Sporothrix schenckii — sporotrichosis)

   • Ulcerative lesions, often along lymphatics ("sporotrichoid spread").

4. Bacterial skin infections

   • (e.g., staphylococcal or streptococcal skin infections)

   • Less likely with the chronic course and specific plaque features but could complicate a primary lesion.

5. Cutaneous tuberculosis (tuberculous chancre, scrofuloderma)

   • Chronic skin ulcers, endemic area, but usually slower progression.

6. Fungal infection — chromoblastomycosis or blastomycosis

   • Nodular, verrucous plaques; more common in tropical regions.

7. Neoplastic processes

   • (e.g., Langerhans cell histiocytosis, rarely squamous cell carcinoma)

   • Very rare in this age and presentation, but ulcerated plaques with rolled borders always need consideration.

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🧠 Key clinical clues that push Leishmaniasis to the top:

• Geography (Venezuela is a hotspot)

• Lesion morphology (ulcer with rolled edge, satellites)

• Timeline (6 weeks)

• Travel and possible exposure to sandflies

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Would you like me to also quickly draft a clinical workup or how you’d confirm diagnosis?
(Like biopsy, smear, PCR, etc?) 🔍

A