Leishmaniasis Diagnosed in the United States Successfully Treated With Miltefosine: A Case Report and Literature Review

Abstract

Leishmaniasis is an infectious disease caused by the parasitic protozoa species Leishmania and is most often transmitted to humans through the bite of a sandfly. The most common manifestation is a cutaneous lesion. Leishmaniasis is endemic to many countries throughout the world but rarely diagnosed in the United States. Here, we report a 64-year-old man with initially undisclosed recent travel to Sudan, an endemic country, who returned to the United States with cutaneous lesions on his forehead and dorsal hand. After failing initial therapy, a biopsy showed amastigotes (the tissue stage of the parasite), chronic inflammation with numerous plasma cells, granulomatous features, focal necrobiosis, and neutrophilic debris, consistent with leishmaniasis. The lesions did not significantly improve with fluconazole, but miltefosine (100-200 mg daily) resulted in remission over an 8-week course. The purpose of this case report is to highlight the importance of including rare infectious organisms in the differential and briefly discuss diagnostic and treatment methods.