Leishmaniasis with oral mucosa involvement

Abstract

Introduction:The term leishmaniasis comprises a group of diseases caused by different protozoan species of the genus Leishmania. There are three main clinical forms of leishmaniasis: visceral, cutaneous and mucocutaneous. Exclusive involvement of the mucosa is very rare. Objectives: To present a case of mucocutaneous leishmaniasis in an elderly patient, discuss the clinical presentation, diagnostic process and treatment emphasizing the distinctions from other granulomatous lesions. Case report: A 71-year-old male presenting with a symptomatic lesion on the hard and soft palate, which had developed over a period of 6 months was evaluated. The oral exam revealed a lesion with multiple ulcerated nodules on the hard and soft palate extending to the oropharynx. The diagnostic hypothesis was chronic infectious disease (paracoccidioidomycose, tuberculosis and leishmaniasis) or squamous cell carcinoma. Histopathological, histochemical and immunohistochemical analysis were performed. A chest x-ray revealed a normal pulmonary pattern. The Montenegro skin test was positive. The definitive diagnosis was leishmaniasis with exclusive oral manifestation and the patient was treated with liposomal amphotericin. Conclusions: Localized oral mucosa leishmaniasis is an uncommon event in an immunocompetent patient. Dentists play an important role in the diagnosis of oral leishmaniasis, which has systemic repercussions.

Mucosal leishmaniasis with primary oral involvement: a case series and a review of the literature

“…Diagnosis is very often a challenge with several reports in the literature of a significantly delayed diagnosis or even an erroneous clinical diagnosis of malignancy (Casolari et al, 2005;Mathur et al, 2006;Tiseo et al, 2008;Pellicioli et al, 2012;Cocuzza et al, 2013;Oryan et al, 2013). Differential diagnosis encompasses other infectious or non-infectious diseases such as fungal infections (blastomycosis), tertiary syphilis, sarcoidosis, paracoccidioidomycosis, histoplasmosis, tuberculosis, leprosy, lethal midline granuloma, pemphigus vulgaris, pemphigoid, plasmacytic gingivitis, (deficiencies) anemia, leukemia, antineutrophilic cytoplasmic antibody (ANCA)-associated (Wegener) granulomatosis, and squamous cell carcinoma (Casolari et al, 2005;Palmeiro et al, 2007;Pellicioli et al, 2012). One further important aspect to be discussed is the difficulty of establishing the diagnosis of infectious diseases with a biopsy.…”

Exclusive Primary Lesion of Oral Leishmaniasis with Immunohistochemical Diagnosis

“…Giemsa and PCR Liposomal amphotericin B (3 mg/kg/day) for 5 days Pellicioli et al [12]. [19] studied 50 cases of postkala-azar dermal leishmaniasis with either H&E stain or IHC analysis, and amastigotes were identified in 50.0 % of samples with the H&E stain, whereas IHC study detected them in 80.0 % of cases.…”

“…We found only 19 cases of leishmaniasis, with involvement reported exclusively in the oral area in the English-language literature [3][4][5][6][7][8][9][10][11][12][13], and 6 cases in immunocompromised patients [3,[5][6][7]. These lesions usually appear as erythema and ulceration or as plaque, papules, and/or exophytic nodules, usually affecting the hard or soft palate and tongue.…”

Orofacial manifestations of mucocutaneous leishmaniasis: a case series from Brazil

“…It is a widely dispersed disease, being endemic in 98 countries, including Brazil. Leishmaniasis classification encompasses different clinical forms 2 ; mucocutaneous leishmaniasis is a chronic form of infection 3 that may manifest in the mucosa after months or years of latency 4 .…”

“…The lymphatic or hematogenous dissemination of amastigotes may occur from the skin to the nasal, oropharyngeal, laryngeal and/or tracheal mucosa. Delayed diagnosis 3,6 and development of primary lesion in the oral mucosa and in the head and neck region can cause dysphagia, dysphonia and dyspnoea 3 .…”