Leishmaniose der Lippen unter dem klinischen Bild einer Mykose

Abstract

A 24-year old German man was complaining of painful ulcers with infiltration of the lips without alteration of the oral mucosa and swelling of the regional lymph nodes. Three months earlier he had visited Israel, Italy, Romania and Bulgaria. He was treated with penicillin, doxycyclin, ciprofloxacin, itraconazole and prednisolone after detection of Candida spec. and staphylococci in another town without any effect. The smear and biopsy were sent to the Robert Koch Institute Berlin. Giemsa stain by phase contrast light microscopy with oil immersion showed extracellular amastigote leishmaniae with clearly stained kinetoplasts. Leishmania major could be detected by PCR investigation. The IgE was elevated, other investigations of the blood and from the lips were inconspicuous. The ulcers healed promptly under the treatment with Pentostam (antimony derivative) 0,1 ml/kg body weight i.m. for 12 days and 15% Paromomycin ointment.

Lip leishmaniasis: a case series with molecular identification and literature review

“…Accordingly, clinical diagnosis of lip leishmaniasis is frequently a challenge with a significantly delayed diagnosis or even an erroneous clinical diagnosis of malignancy [12, 19, 25]. The most important diseases that must be taken into account in differential diagnosis are herpes labialis [26], syphilitic chancre [27], Melkersson-Rosenthal syndrome [28], orofacial granulomatosis [28], cheilitis granulomatosa [29, 30], Wegener granulomatosis [12, 19, 25], oral Crohn’s disease [31], sarcoidosis [32, 33], skin tuberculosis [34], discoid lupus erythematosus [34], lymphoma [34], foreign body giant cell granuloma [12, 19, 25, 28], leprosy [35], mycotic infection [36], fibroma, lipoma, and neuroma [37], basal cell carcinoma [38], and squamous cell carcinoma [34, 39]. The diagnosis is easier to make if typical CL lesions are present elsewhere on the skin.…”