First imported case of New World leishmaniasis in Romania: diagnostic and therapeutic challenges in a non-endemic country

BACKGROUND: Leishmaniasis is a vector-borne protozoan disease with cutaneous, mucocutaneous, and visceral forms. In Europe, most cases involve Old World species, while imported New World infections are rare. We report the first imported human case of New World cutaneous leishmaniasis in Romania. CASE PRESENTATION: A 25-year-old woman developed progressive ulcerative lesions on her left arm after travel to Panama and Costa Rica. Initial biopsy revealed granulomatous inflammation without identifying the agent. A second biopsy detected amastigotes within macrophages, and molecular analyses (ITS1 sequencing, hsp70 phylogenetic analysis) identified Leishmania panamensis. The patient received oral miltefosine for 28 days, with gradual improvement and complete healing with atrophic scars. No relapse occurred 473 days post-treatment. CONCLUSIONS: This case highlights diagnostic challenges in non-endemic regions, emphasizing the need to raise clinical awareness and improve access to molecular tools for prompt recognition and management of imported leishmaniasis in Eastern Europe.