Challenges in the treatment of cutaneous leishmaniasis caused by L. braziliensis in four travelers: a case series

We describe a group of four travelers returning to the United States and Canada who acquired Leishmania braziliensis infection in the Peruvian Amazon. Pentavalent antimonials are the preferred treatment option for cutaneous leishmaniasis (CL) in most endemic countries in Central and South America. However, we initially treated our patients with liposomal amphotericin B (LAB) and miltefosine since these are the only two available Food and Drug Administration approved drugs in the United States. Refractory disease was common as three of the four travelers required repeated courses of miltefosine and two also received LAB. One patient required intravenous therapy with meglumine antimoniate (NMG), and one received intralesional NMG. Given the increasing number of cases of CL identified in the United States, there is an urgent need for expanded access to pentavalent antimonials for treating leishmaniasis acquired in Central and South America.