Don't Pack a Pest: Leishmania Guyanensis in Southwest Michigan.

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.