Bite the hand that sprays you

Area of Science:

• Dermatology
• Infectious Diseases
• Tropical Medicine

Background:

• Cutaneous leishmaniasis is a parasitic disease transmitted by sandflies, prevalent in tropical and subtropical regions.
• Leishmania panamensis is a species of Leishmania parasite known to cause cutaneous leishmaniasis, particularly in Central and South America.
• Exposure to infected sandflies during travel to endemic areas is the primary risk factor for acquiring the infection.

Observation:

• A 56-year-old man presented with a hand lesion after returning from Costa Rica.
• The patient developed multiple ulcerated nodules in a sporotrichoid pattern on his right arm.
• Lesions included an ulcer on the dorsum of the right hand, an ulcerated nodule near the right earlobe, and an ulcer on the right wrist.

Findings:

• Skin biopsy confirmed cutaneous leishmaniasis due to Leishmania panamensis.
• The clinical presentation included multiple nodular lesions progressing in a linear, sporotrichoid fashion along the lymphatic drainage of the right arm.
• No mucocutaneous involvement was observed.

Implications:

• This case highlights the importance of considering cutaneous leishmaniasis in travelers presenting with unusual skin lesions after visiting endemic areas.
• Early diagnosis through skin biopsy and appropriate treatment are crucial for managing cutaneous leishmaniasis.
• Miltefosine demonstrated efficacy as an oral treatment option for Leishmania panamensis-induced cutaneous leishmaniasis.