Imported cutaneous leishmaniasis in a short-term traveler returning from Central Mali - The role of PCR.

Leishmaniasis is a parasitic infection caused by the obligate intracellular protazoa leishmania. The most commonly encountered form is cutaneous leishmaniasis (CL), which generally manifests as a chronic, painless ulcer. Recent increases in the incidence of CL worldwide due in large part to increased immigration and international travel, combined often with the lack of familiarity with the disease in non-endemic settings, pose the continued problems of delayed diagnosis and inappropriate treatment. A case is described of imported cutaneous leishmaniasis occurring in a 48 year-old male who presented with multiple painless, progressively ulcerating lesions after returning from a one week trip to Bandiagara, Mali, West Africa. After four months of misdiagnoses and ineffective treatments, he was referred to a tropical disease specialist where the diagnosis was made with a skin biopsy followed by a tissue impression smear, culture and PCR. Appropriate treatment was initiated and the lesions resolved with minimal scarring. The goals of this case report are threefold: first, to stress the importance of associating chronic ulcers in a traveler with potential cutaneous leishmaniasis; second, to emphasize the clinical utility of PCR for the diagnosis; and third, to discuss the clinical approach to treatment.