cutaneous leishmaniasis is a common protozoan disease , caused by leishmania ; and it is an important public unusual clinical presentations have been reported occasionally and include annular , sporotrichoid , palmoplantar , erysipeloid , whitlow , paronychial and impetigo- form ( 2 - 4 ) . we present a patient with eczema form , a very rare and chronic variant of cutaneous leishmaniasis . a 27- year  old man was referred to our clinic with a 3- month history of an exudatng lesion on the hand ( fig . it had started as a small insect - bite - like lesion and progressed slowly . he denied any history of burns , trauma , drug intake or allergic disorder . the patient denied risk factors associated with hiv and also reported no chills , fever , pain or constitutional symptoms . the total blood count , crp , erythrocyte sedimentation rate ( esr ) , fbs , and intradermal purified protein derivative ( ppd ) skin test and hiv serology were all normal . 
 
 on examination previous treatments icluding steroid , antihistamine and antibiotics failed to heal the lesion and its slow progression . special stains and cultures were negative for acid- fast bacteria , fungi , and other bacteria . because thepatientwas residingin an endemic area ofdisease , wasaskedtoperform cutaneous leishmaniasis test and touch preparations stained with wright  giemsa preparation were positive for leishmania . the patient was treated with meglumineantimoniate ( glucantime ) , pentavalent antimony , at a dosage of 20 mg / kg per day intra - muscularly for 20 days ( treatment administered by center for control diseases of iran ) . after completion of therapy , the lesion had partially healed , and after 3 months , the ulcer healed completely . the side effect of meglumineantimoniate was mild arthralgias , myalgias , and pain at the injection site but otherwise tolerated the medication well . rodents and canids are as common reservoir hosts and humans as incidental hosts ( 1 ) . the incubation period ranges from a week to many months . lesions typically appear on exposed areas of the body . the first manifestation is usually a papule at the site of the sandfly bite , which progressively increase in size and eventually ulcerate . multiple primary lesions , regional adenopathy , sporotrichoid form , zoster- form , impetigo  form , erysipeloid , and whitlow- form are variably present ( 4 - 7 ) . here , we described a case of cutaneous leishmaniasis showing unusual presentation , resembling eczema on the hand with a response to treatment with meglumineantimoniate ( 8) . the precise pathogenesis of the eczema form of the cutaneous leishmaniasis has been poorly documented . the clinical manifestation in cutaneous leishmaniasis depends on the infecting leishmania species and host immune response , which is largely mediated through cellular immunity . other factors include the site of infection , the number of parasites inoculated and nutritional status of the host . however , in the eczematous form of the cutaneous leishmaniasis , one factor could be the epidermal invasion by leishmania causing an intense cell- mediated immune response leading to severe inflammatory and eczematous changes ( 7,9 ) . 
 
 in our report the large size and the eczematous appearance of the lesion was in itself very rare our patient was an otherwise healthy , young adult with no history of other skin or systemic disease or atopy . whether the eczematous appearance resulted from an atypical leishmania strain or from lack of response or a specific immune response is not clear ( 10 ) . 
 
 in another report a very rare case of bilateral and symmetrical cutaneous leishmaniasis was presented as eczema - like eruptions with localization exclusively on dorsal aspect of both hands ( 11 ) . in another study , the diagnosis was confirmed to be cutaneous leishmaniasis as eczema - like eruptions by histological examination and polymerase chain reaction assay of the skin biopsy . in our study in endemic areas or in cases with recenet travel to endemic areas , it is necessary for the physician to be aware of atypical skin lesion and it should be investigated for cutaneous leishmaniasis .
cutaneous leishmaniasis may present with clinical presentation such as zosteriform , sporotrichoid and erysipeloid . 
 the eczema variant has rarely been reported . 
 we report a 27- year- old patient with atypical cutaneous leishmaniasis resembling eczema on the hand of a man in yazd province in the central of iran .