Introduction: Cutaneous leishmaniasis is non-endemic in the Philippines. Antiparasitic pentavalent antimonials are acknowledged as first-line therapy for all forms of the disease. Amphotericin B is the second drug of choice but its use is limited due to side effects. Case Summary: We present a case of a 32- year-old male overseas Filipino worker who presented with “volcaniform plaques” (nodules and plaques with central crater) and surrounding satellite erythematous papules on the trunk, and extremities after returning from Iraq. A diagnosis of cutaneous leishmaniasis was confirmed by the histopathologic findings of a granulomatous inflammatory infiltrate with round to oval basophilic structures in the cytoplasm of macrophages (Leishman bodies) in the dermis, which were highlighted prominently by Giemsa stain. The patient showed poor response to treatment with 4 weeks of oral Rifampicin 1200 mg daily divided into 2 doses. He was shifted to oral Itraconazole 400 mg daily divided into 2 doses for 6 weeks with dramatic improvement. Conclusion This case report highlights the favorable therapeutic response of cutaneous leishmaniasis to oral itraconazole and hence, may be recommended as first-line medication to treat infected overseas workers from endemic areas who seek treatment in the Philippines.
Leishmaniasis