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

Am J Trop Med Hyg. 2020 Oct;103(4):1493-1495. doi: 10.4269/ajtmh.20-0219.

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.

Publication types

  • Case Reports

MeSH terms

  • Antiprotozoal Agents / therapeutic use
  • Cytokines / drug effects
  • Cytokines / metabolism
  • Deglutition Disorders / drug therapy
  • Deglutition Disorders / etiology
  • Humans
  • Leishmania braziliensis / drug effects
  • Leishmania braziliensis / isolation & purification*
  • Leishmaniasis, Mucocutaneous* / diagnosis
  • Leishmaniasis, Mucocutaneous* / drug therapy
  • Leishmaniasis, Mucocutaneous* / pathology
  • Macrophages / parasitology
  • Male
  • Meglumine Antimoniate / therapeutic use
  • Middle Aged
  • Nasopharynx / parasitology
  • Nasopharynx / pathology
  • Oropharynx / parasitology
  • Oropharynx / pathology
  • Skin / parasitology
  • Skin / pathology

Substances

  • Antiprotozoal Agents
  • Cytokines
  • Meglumine Antimoniate