Cutaneous Leishmaniasis After a Trip to Costa Rica

We present a case of cutaneous leishmaniasis in a patient with chronic ulcerating skin lesions who recently traveled to Costa Rica. A 21-year-old male presented with a non-healing ulcer of six weeks duration on the right lower extremity. The patient was treated with multiple courses of antibiotics as empiric treatment for cellulitis with no response, and a decision was made to biopsy the lesion. The initial skin biopsy was negative for cultures and pathology. Due to high suspicion of Leishmania, a repeat biopsy was done, and the sample was sent to the US Centers for Disease Control and Prevention for further evaluation; it was positive for Leishmania spp. Though treatment of Leishmania varies depending on the species, the patient was treated with miltefosine due to the prevalence of Leishmania guyanensis in Costa Rica. The patient had an appropriate response with good wound healing after eight weeks of therapy and wound care.