Leishmania (Viannia) guyanensis Causing Localized Cutaneous Leishmaniasis in a Traveler

We report on a 66-year-old male who presented for evaluation of rapidly expanding lesions on his lower extremities. He first noticed these lesions following a trip to Costa Rica, in which he was bitten by several unidentified bugs. He was initially treated empirically with antibiotics in the outpatient setting with no improvement of his symptoms. His lesions continued to expand and spread locally which prompted further workup with a biopsy of one of his lesions. He was ultimately found to have Leishmaniasis (Viannis) guyanensis confirmed by microscopy and polymerase chain reaction. He was treated with aggressive wound care and amphotericin B due to the risk of progressing to involve his mucosa.