A skin ulcer in a returning traveler caused by Leishmania panamensis

Abstract

An 18-year-old male patient presented with an ulcer over the dorsal right fourth finger. He had just returned from a three-month mission trip to Costa Rica, Ecuador and Peru, where he noticed a painless papule over the dorsal right fourth finger that progressively increased in size and eventually developed an ulcer (Figure 1). Limited debridement was performed in the office by plastic surgery. Pathology showed extensive acute and chronic inflammation, with organisms consistent with Leishmania (Figures 2 and 3).