Pediatric Cutaneous Leishmaniasis: A Case Series in a Montreal Tertiary Care Hospital.

The diagnosis and management of cutaneous leishmaniasis (CL) pose important challenges in the pediatric population. We determined CL clinical characteristics in infected children in Montreal, Canada. Demographic and clinical data from medical records of children with CL were retrieved retrospectively (2004-2023) at Sainte-Justine University Medical Center. Fourteen children (9 boys and 5 girls) with CL were first- (9) or second- (5) generation immigrants who immigrated from or travelled to their country of origin. CL developed post arrival/return to Canada (mean 6.6 months). The mean age at onset was 8.4 years (range 3-16 years). Lesions were multiple in 10 cases, with faces and legs more frequently involved. The mean diagnostic delay was 3 months, largely due to limited access to healthcare and initial misdiagnoses (range: 1-7 months). Histopathology (12), polymerase chain reaction (8), or both (7) confirmed the diagnosis. Two patients cleared CL without treatment, while 2 others showed clinical improvement with antileishmanial agent treatment alone. Patients were treated with fluconazole (7), liposomal amphotericin B (6), either alone or in association, and intralesional meglumine antimoniate (2). The mean time between CL onset and resolution was 5 months (range 1-10 months), resulting in atrophic scars in 10 patients with known outcome. Awareness of the occurrence of CL in children living in non-endemic countries should result in earlier diagnosis and treatment and better outcomes.