# A Case of Cutaneous Leishmaniasis: Awareness and Recognition in Low-Endemic Areas

## TL;DR

This paper presents a case of cutaneous leishmaniasis in the U.S., highlighting diagnostic delays and the need for better awareness and PCR testing.

## Contribution

The novelty lies in emphasizing the under-recognized burden of leishmaniasis in low-endemic U.S. areas and advocating for PCR testing.

## Key findings

- A 50-year-old woman's CL diagnosis was delayed due to atypical presentation and negative special stains.
- PCR testing was crucial for confirming leishmaniasis despite negative traditional diagnostic methods.
- The case highlights the need for increased awareness and improved diagnostic approaches in the U.S.

## Abstract

Leishmania is a parasitic organism that causes multiple clinical manifestations, including cutaneous leishmaniasis (CL), characterized by skin ulcers and satellite lesions. It is endemic to 98 countries, notably rural tropical regions. Although cutaneous forms are endemic to the United States, most cases occur among travelers who have traveled abroad. While international cases are well established, the United States demonstrates a substantial deficit in recognition and reporting of CL. We present the case of a 50-year-old woman who developed ulcerative lesions on the right auricle following an insect bite in Colombia. The patient was evaluated by multiple specialties over the course of one year before being diagnosed with CL. This case demonstrates a pattern of atypical presentations of leishmaniasis, with negative special stains on multiple specimens but detection by polymerase chain reaction (PCR). Our goal is to raise awareness of leishmaniasis in the United States and increase the use of PCR testing for diagnosis to make diagnosis and treatment more efficient.