# Miltefosine Failure and Amphotericin B Success in the Treatment of a Case of Cutaneous Leishmania Braziliensis in a Recent Traveler in Belize and Guatemala

## TL;DR

A man with cutaneous leishmaniasis did not respond to miltefosine but recovered after switching to amphotericin B, highlighting the need for species identification and region-specific treatment.

## Contribution

Demonstrates the importance of species identification and regional context in treating cutaneous leishmaniasis.

## Key findings

- Miltefosine was ineffective for L. braziliensis in this case.
- Amphotericin B successfully resolved the lesions after species identification.
- Treatment outcomes may vary by region due to drug resistance or potency differences.

## Abstract

We report the case of a 53-year-old male with recent travel to Guatemala and Belize who was diagnosed with cutaneous leishmaniasis (CL). He was treated empirically with miltefosine with no improvement and switched to amphotericin B upon species identification of L. braziliensis, resulting in the resolution of his lesions. This case demonstrates that clinicians should recognize the importance of systemic therapy for treating complex CL, as well as the importance of identification of species type for tailoring treatments. Furthermore, while miltefosine has proven efficacious for CL in many New World locales, it has demonstrated lower cure rates for CL in Guatemala, and thus identification of the region of origin of the CL infection is imperative for further guiding treatment, which may vary according to the differences in drug potency or region-specific resistance rates.