Treatment of a Complex Ulcerative Lesion Caused by Leishmaniasis: A Case Report

Abstract

Cutaneous leishmaniasis, a neglected tropical disease caused by Leishmania parasites, poses a public health challenge in Mexico, particularly in endemic regions where L. mexicana predominates. Transmitted via Lutzomyia sandflies, the disease manifests primarily as skin ulcers, with "chiclero's ulcer" being a notable variant. Diagnosis relies on clinical suspicion, epidemiological context, and laboratory confirmation, utilizing parasitological (smear microscopy, culture, biopsy) and molecular (PCR) techniques. A case is presented of a 25-year-old male from Venezuela, recently arrived in Mexico, who developed multiple suppurative cutaneous lesions following arthropod bites. Initial treatments were ineffective, but diagnosis via lesion culture revealed Leishmania co- infected with Staphylococcus haemolyticus, leading to targeted antibiotic therapy followed by intravenous meglumine antimoniate (Glucantime), resulting in clinical improvement and re-epithelialization of the ulcers. Treatment strategies for cutaneous leishmaniasis in Mexico encompass both local and systemic options, requiring individualized approaches based on patient and lesion characteristics, as well as adherence to national and international guidelines. This case underscores the importance of considering leishmaniasis in the differential diagnosis of cutaneous ulcers, even in non-endemic areas, and highlights the successful management of a complex case with systemic antimoniate therapy.