Treatment-Refractory New World Cutaneous Leishmaniasis Misdiagnosed as Recurrent Cellulitis in a UK Traveler Returning From the Amazon

Cutaneous leishmaniasis is an uncommon consideration in non-endemic settings, where it may closely resemble bacterial skin infections and result in diagnostic delay. We report the case of a previously healthy young man in the United Kingdom who developed a progressively enlarging ulcer on the dorsum of the hand with associated nodular lymphocutaneous spread following recent travel to the Amazon rainforest. The lesion evolved over several weeks and was repeatedly treated as recurrent cellulitis with multiple courses of antibiotics, without clinical improvement. Histopathological examination and molecular testing ultimately confirmed New World cutaneous leishmaniasis caused by the Leishmania (Viannia) subgenus. Initial therapy with liposomal amphotericin B was limited by nephrotoxicity and incomplete response, necessitating multidisciplinary review and alternative treatment with meglumine antimoniate, which resulted in complete clinical resolution. This case highlights the diagnostic challenges of cutaneous leishmaniasis in returning travelers and emphasizes the importance of early biopsy, species identification, and specialist involvement when chronic or atypical skin lesions fail to respond to standard antimicrobial therapy.