Miltefosine Failure and Amphotericin B Success in the Treatment of a Case of Cutaneous Leishmania Braziliensis in a Recent Traveler in Belize and Guatemala

Michelle Y Ko; Emilie Fowler; Amanda Scott; Daniel Z Uslan

doi:10.1155/crdi/6644758

Miltefosine Failure and Amphotericin B Success in the Treatment of a Case of Cutaneous Leishmania Braziliensis in a Recent Traveler in Belize and Guatemala

Case Rep Infect Dis. 2025 Jul 5:2025:6644758. doi: 10.1155/crdi/6644758. eCollection 2025.

Authors

Michelle Y Ko¹, Emilie Fowler², Amanda Scott³, Daniel Z Uslan⁴

Affiliations

¹ David Geffen School of Medicine at the University of California, Los Angeles, California, USA.
² Division of Dermatology, David Geffen School of Medicine at the University of California, Los Angeles, California, USA.
³ Santa Barbara Lifestyle Medicine, Santa Barbara, California, USA.
⁴ Division of Infectious Disease at the David Geffen School of Medicine at the University of California, Los Angeles, California, USA.

Abstract

We report the case of a 53-year-old male with recent travel to Guatemala and Belize who was diagnosed with cutaneous leishmaniasis (CL). He was treated empirically with miltefosine with no improvement and switched to amphotericin B upon species identification of L. braziliensis, resulting in the resolution of his lesions. This case demonstrates that clinicians should recognize the importance of systemic therapy for treating complex CL, as well as the importance of identification of species type for tailoring treatments. Furthermore, while miltefosine has proven efficacious for CL in many New World locales, it has demonstrated lower cure rates for CL in Guatemala, and thus identification of the region of origin of the CL infection is imperative for further guiding treatment, which may vary according to the differences in drug potency or region-specific resistance rates.

Keywords: Belize; Guatemala; amphotericin B; cutaneous leishmaniasis; miltefosine.

Publication types

Case Reports