Case Report: Unusual Presentation of Pharyngeal Mucosal Leishmaniasis due to Leishmania (Viannia) braziliensis

Abstract

Mucosal leishmaniasis (ML) affects predominantly the nose and occurs usually weeks or months after the cure of the primary cutaneous lesion. The pathology of ML is characterized by an exaggerated inflammatory reaction with infiltration of lymphocytes, macrophages, and plasma cells. There is also a paucity of parasites and a strong delayed-type hypersensitivity reaction. Herein, we report a case of a young man who had a large ulcer in his left leg and complained of dysphagia. In nasofibrolaryngoscopy, there were nodular lesions in the oropharynx and rhinopharynx. The skin lesion biopsy showed a chronic inflammation with amastigotes inside macrophages, and DNA of Leishmania braziliensis confirmed the diagnosis of ML in tissue biopsied from the pharynx. The leishmaniasis skin test was negative. Cytokine evaluation showed lack of production of interferon (IFN)-γ, interleukin (IL)-1β, and IL-17 with enhancement of these cytokine levels after cure.

Unusual Observations in Leishmaniasis—An Overview

“…The smooth and erythematous swelling of the lower lip (chelitis) and granulomatous disease of the endolarynx [ 220 ] as well as lesions on the conjunctiva of the upper and lower eyelid [ 221 ] ( Figure 5 c) are some other unusual morphological variants of MCL. Oropharyngeal mucosal leishmaniasis ( Figure 5 d) is also a rare presentation [ 222 ]. Sublingual leishmaniasis with atypical pseudotumoral morphology [ 223 ] and lingual leishmaniasis ( Figure 5 e) with lymphoid-like tissue swelling on the dorsal part of the tongue [ 224 ] are some of the rare observations in MCL.…”

“… Atypical sites/locations of MCL lesions: ( a ) focal hard whitish lesions on the true vocal cords of a patient with MCL [ 202 ]; ( b ) lesions on hard and soft palate and cobblestone appearance of lesions on hard palate of MCL patient [ 213 ]; ( c ) lesions on conjunctiva of the upper and lower inner eyelids [ 221 ]; ( d ) multiple granulomatous MCL lesions on the posterior wall of the oropharynx [ 222 ]; and ( e ) lingual leishmaniasis showing swelling on the dorsal part of lingual tissue [ 224 ]. …”