IntroductionTraumatic arteriovenous fistula (TAVF) may be challenging to diagnose and can be misjudged as skin lesions or ulcers, including cutaneous leishmaniasis. Here, we present a patient with TAVF misdiagnosed and treated as cutaneous leishmaniasis.Case presentationA 36-year-old male presented with a non-healing venous ulcer in his left leg, which was misdiagnosed and treated as cutaneous leishmaniasis. He was referred to our clinic, where color Doppler sonography showed arterial flow in the left great saphenous vein, and Computed tomographic (CT) angiography revealed left superficial femoral artery fistula to the femoral vein. The patient had a history of shotgun injury six years ago. Surgical closure of the fistula was done. The ulcer healed completely one month after the surgery.Discussion and conclusionTAVF may present as skin lesions or ulcers. Our report emphasizes the importance of thorough physical examination and history taking and the use of color Doppler sonography in order to avoid unnecessary diagnostic and therapeutic modalities.