Cutaneous leishmaniasis is a significant global health issue that often affects travelers returning from endemic regions. Recently, medical professionals identified the first imported case of New World cutaneous leishmaniasis in Romania. A 25-year-old woman developed progressive skin lesions after visiting Panama and Costa Rica. Because Romania is a non-endemic country, the diagnosis initially proved difficult.

Initially, a standard skin biopsy showed only nonspecific inflammation. Consequently, the medical team performed a second biopsy. This deeper investigation successfully identified amastigotes within the patient's macrophages. To confirm the specific species, specialists used advanced molecular tools. Both ITS1 sequencing and hsp70 phylogenetic analysis verified the presence of Leishmania panamensis.

Effective Treatment for New World Cutaneous Leishmaniasis

Clinicians chose oral miltefosine as the primary treatment for this patient. She followed a 28-day regimen, which led to a gradual but steady improvement of her skin lesions. Ultimately, the ulcers healed completely, leaving only minor atrophic scars. Most importantly, follow-up evaluations after 473 days showed no signs of disease relapse.

This case emphasizes why doctors in non-endemic regions must stay alert. Early recognition of New World cutaneous leishmaniasis prevents the progression to more severe mucocutaneous forms. Therefore, healthcare systems should prioritize access to molecular diagnostic tools for travelers with suspicious skin lesions.

Frequently Asked Questions

What are the symptoms of New World cutaneous leishmaniasis?

Symptoms typically include progressive, painless skin ulcers that develop weeks or months after a sandfly bite. These lesions often appear on exposed areas like the arms or face.

How is miltefosine used to treat this condition?

Miltefosine is an oral medication usually taken for 28 days. It is highly effective against specific species like L. panamensis and offers a convenient alternative to injectable treatments.

Why is molecular testing necessary for diagnosis?

Molecular tests such as PCR and hsp70 sequencing are essential for species identification. Different Leishmania species require different management strategies and carry varying risks of complications.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or a professional diagnosis. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Mihalca AD et al. First imported case of New World leishmaniasis in Romania: diagnostic and therapeutic challenges in a non-endemic country. Infect Dis Poverty. 2026 May 02. doi: undefined. PMID: 42067954.

Soto J, Berman J. Treatment of New World cutaneous leishmaniasis with miltefosine. Trans R Soc Trop Med Hyg. 2006 Dec;100 Suppl 1:S34-40. doi: 10.1016/j.trstmh.2006.02.022.

World Health Organization. Leishmaniasis Fact Sheet. [Online] Available at: https://www.who.int/news-room/fact-sheets/detail/leishmaniasis