# Don’t Pack a Pest: Leishmania Guyanensis in Southwest Michigan

## TL;DR

A woman in Michigan was diagnosed with Leishmania guyanensis after a trip to Costa Rica and successfully treated with miltefosine.

## Contribution

This case highlights the importance of considering rare tropical infections in non-endemic regions.

## Key findings

- Leishmania guyanensis was confirmed via skin biopsy after initial misdiagnosis.
- Treatment with miltefosine led to complete resolution of the patient's rash.
- The patient had no recollection of sandfly bites during her trip to Costa Rica.

## Abstract

Leishmaniasis is a protozoal infection that is typically transmitted through the saliva of a female Phlebotomine sandfly and can result in devastating mucocutaneous infections if not identified and treated quickly. Here we present a case of cutaneous Leishmania guyanensis in a 49-year-old woman who had recently gone on a trip to Costa Rica and was unaware of any bites she may have sustained while being there. The patient initially presented with a facial rash and was seen by both her primary care physician and dermatology before receiving a referral to infectious disease. After a prolonged work-up, during which she was given antibiotics and steroids, skin biopsy was able to confirm the diagnosis of Leishmania guyanensis, and she was started on a four-week course of miltefosine with complete resolution of her rash.