Published online Jan 15, 2021. doi: 10.5495/wjcid.v11.i1.19
Peer-review started: August 7, 2020
First decision: September 21, 2020
Revised: October 19, 2020
Accepted: October 26, 2020
Article in press: October 26, 2020
Published online: January 15, 2021
Processing time: 152 Days and 18.7 Hours
Reports of leishmaniasis are scarce in North America. It is considered to be one of the neglected tropical diseases. It is seen in immigrants from endemic areas to United States. Treatments are not readily available in the United States. Untreated or inadequately treated cutaneous leishmaniasis not only causes localized disfigurement but can advance to more permanent and devastating mucosal disfigurement and perforation, if caused by a species that can also cause mucocutaneous leishmaniasis.
A 42-year-old human immunodeficiency virus negative male immigrant from Honduras presented to the emergency department of our facility in Louisiana with a 2-mo history of a left lower extremity ulcer. It started as a painless blister that progressed in size and developed into other smaller lesions tracking up the thigh and became tender and erythematous. Clinically looked nontoxic and healthy. He was afebrile. Blood tests, except inflammatory markers, were within normal limits. The cellulitis of the leg was treated with 6 d of vancomycin that also relieved the pain. Skin biopsy was obtained, and histopathology was suspicious for leishmania. Polymerase chain reaction/deoxyribonucleic acid sequencing done by centers for disease control and prevention confirmed the diagnosis as Leishmania panamensis. There was no involvement of naso-oropharyngeal mucosa, confirmed by otolaryngology. The patient was treated with miltefosine for 28 d. Clinic follow-up after approximately 11 mo revealed a healed skin ulcer.
Cutaneous leishmaniasis should be in the differential diagnosis of skin ulcers of travelers from endemic areas. Awareness regarding diagnosis and treatment of leishmaniasis needs to be enhanced.
Core Tip: This case highlights the importance of prompt and accurate diagnosis, and appropriate treatment of cutaneous leishmaniasis to prevent further complications and advancement to mucosal form. It should be considered in the differential diagnosis of skin lesions with appropriate epidemiologic context. Oral therapy with miltefosine is available for use as in this case. It is important to evaluate for human immune-deficiency virus disease since presentation and complications in immunosuppressed individuals can be more severe.