Cutaneous Leishmaniasis Requiring Polymerase Chain Reaction (PCR)-Based Diagnosis

Cutaneous leishmaniasis, a protozoal skin infection transmitted by the bite of infected female phlebotomine sandflies, can present a diagnostic challenge outside endemic regions. We describe a twenty-nine-year-old woman who recently emigrated from Ecuador and presented with an enlarging ulcer on the left thigh that failed to respond to multiple courses of antibiotics. Histopathology and tissue culture from skin biopsies were nondiagnostic, but polymerase chain reaction (PCR) testing identified Leishmania braziliensis. Intravenous liposomal amphotericin B resulted in complete ulcer resolution within two months. This case highlights the importance of considering leishmaniasis as a diagnosis for non-healing skin ulcers in patients from endemic areas and underscores the value of molecular pathogen identification.