# A case of adnexal cutaneous leishmaniasis in Washington DC

## TL;DR

A 68-year-old woman in Washington DC was diagnosed with a rare case of cutaneous leishmaniasis caused by Leishmania aethiopica after initial treatments failed.

## Contribution

This paper reports a rare non-endemic case of Leishmania aethiopica in the US, emphasizing the need for broad differential diagnosis in urban settings.

## Key findings

- The patient's symptoms were initially misdiagnosed as viral or autoimmune, leading to ineffective treatments.
- A delayed punch biopsy confirmed leishmaniasis, and oral miltefosine resolved the symptoms completely.
- The case highlights the importance of considering non-endemic diseases in patients with travel histories.

## Abstract

To report a rare non-endemic case of Leishmania aethiopica in Washington DC.

A 68-year-old female presented for a routine examination with a complaint of right upper eyelid lesions for the past 5 months. On examination, a cluster of elevated and erythematous lesions extending from the medial canthus to the brow area of the right eye were seen. Initial treatment with Valtrex based on a suspected viral etiology failed. Although a biopsy was recommended at this time, the patient declined, and subsequent workup included nasolacrimal duct irrigation, blood work to rule out autoimmune etiology, a course of doxycycline, and an MRI, which yielded no improvement. Upon progression of the lesions into persistent plaques on the eyelids, a punch biopsy was performed, confirming leishmaniasis. The patient was then started on a 28-day course of oral miltefosine which led to complete resolution of her symptoms.

This case underlines the importance of a broad differential including non-endemic diseases, particularly in urban areas with frequent patient travel. Furthermore, the delayed punch biopsy in this case highlights the importance of patient counseling to ensure prompt diagnosis and treatment.