Localized mucosal leishmaniasis caused by Leishmania infantum mimicking cancer in the rhinolaryngeal region

Abstract

The clinical, microbiological, and histopathological findings of six patients with mucosal leishmaniasis are reported. Five of these patients were Spanish with no history of travel abroad, while the other was from Bolivia but had lived in Spain for more than 5 years. Two patients had no underlying disease, while the other four had several other medical conditions. Lesions were located in the nose in three patients and in the larynx in the other three. Symptoms included difficulty in swallowing, nasal obstruction, dysphonia, and polypoid lesions mimicking cancer. The diagnosis was based on the identification of parasites, or on PCR assay or culture. Five patients were treated with liposomal amphotericin B and the other with antimonial compounds.

Recurrence of visceral and muco-cutaneous leishmaniasis in a patient under immunosuppressive therapy

“…However, the recurrence of cutaneous lesions together with VL relapse as well as the localized nature of the cutaneous lesions rather suggests CL. Diagnosis of mucosal lesions located in the nose is complex since lesions often mimic neoplastic processes or necrotizing vasculitis [15]. …”

Orofacial manifestations of mucocutaneous leishmaniasis: a case series from Brazil

“…The diagnosis of mucocutaneous leishmaniasis can be difficult 7 . In older lesions, few parasites are usually detected by microscopy or culture and the clinical aspect may resemble neoplasia 1,8 . Orofacial symptoms depend on the localization of the lesions and may include nasal obstruction, difficulties in swallowing, mucosal bleeding and/or hoarseness 8 .…”

“…In older lesions, few parasites are usually detected by microscopy or culture and the clinical aspect may resemble neoplasia 1,8 . Orofacial symptoms depend on the localization of the lesions and may include nasal obstruction, difficulties in swallowing, mucosal bleeding and/or hoarseness 8 . Destructive lesions of the mucosa contain few parasites, with high levels of tumor necrosis factor (TNF) suggesting an unmodulated immune response with increased production of proinflammatory cytokines responsible for tissue damage 9 .…”

Uso da anfotericina B lipossomal e de outras drogas no tratamento de pacientes com leishmaniose mucosa: análise da experiência em um serviço de referência para o diagnóstico e tratamento das leishmanioses, 2000-2015

“…Em relação às formulações lipídicas, foram encontradas, proporcionalmente, quase 2 vezes mais interrupções com o uso da ABCL do que com a AFBL, semelhante a Wingard et al (2000), que encontraram quase 2,5 vezes mais interrupções com a ABCL, fruto de elevadas taxas de eventos adversos relacionados à infusão. A taxa de interrupção com o uso da AFBL foi em torno de 30%, maior do que os valores geralmente descritos na literatura, que variam entre 0 e 20% (Cunha et al, 2015;Cobo et al, 2016;Guery et al, 2017), e foram obtidas taxas menores de interrupção com o uso do antimonial em relação a alguns trabalhos, 44% versus 65%, respectivamente (Solomon et al, 2013…”

“…porém, descreveram 43 pacientes com leishmaniose tegumentar tratados com AFBL, sendo 7 casos de LM, e relataram apenas 57,1% (4/7) de cicatrização nestes pacientes, com 2 falhas e 1 recidiva. A mediana de dose final por eles relatada foi de 20 mg/kg, mas os autores não detalharam quais foram as doses nos casos dos pacientes com LM Cobo et al (2016). obtiveram 1 falha entre os 5 pacientes tratados com a AFBL para LM, e este paciente sem sucesso terapêutico usou uma dose cumulativa final muito baixa, de 1000 mg. Doses maiores que 20 mg/kg parecem ter um desfecho melhor no tratamento da LM.Um outro estudo, que usou dose cumulativa de AFBL entre 20 e 25 mg/kg, encontrou, em 6 pacientes avaliados, 83,3% de sucesso -devido a 1 caso de recidiva(Cunha et al, 2015).…”