Nasal Manifestations of Cutaneous Leishmaniasis: A Case Report

Introduction: Leishmaniasis is an endemic disease caused by a protozoan, whose vector is a mosquito. It could affect skin and mucosa (tegumentary) or visceras (visceral). Mucosa inflammation with congestion and secondary ulceration occur as the typical manifestation. The diagnosis is through identification of the parasites on the tissue by pathological examination or by the Montenegro skin test.

Objectives: This study aims to describe a case with unusual nasal mucosa and skin manifestations of leishmaniasis.

Case Report: A 79-year-old male patient, farmer, presented with progressive nasal complains. He has a history of septoturbinectomy several years ago. He uses hydroxyurea for essential thrombocytosis. Rhinoscopy shows septal perforation and no inferior turbinates. Biopsy showed chronic mucosal inflammation. Patient was followed and instructed to do nasal irrigations with saline and to do a rheumatologic evaluation. One year later, he developed several ulcers in the nasal mucosa, nasal itching, and hyperemia of the external nasal skin. It resulted in a large eroded lesion with papular edges in the nasolabial folds and developed destruction of the columella. Endoscopy showed diffuse mucosal crusting. Biopsy showed chronic granulomatous inflammation. A second biopsy ruled out fungal infection. Montenegro skin test was performed and a positive response was noted (13 mm). Glucantime was prescribed. The patient was discharged 30 days later, showing a significant local improvement.

Conclusion: The present case shows the importance of following patients with unusual nasal mucosa lesions and also, that serial biopsies might be necessary to the diagnosis. Early diagnosis and proper treatment is essential to avoid the local destructive evolution of the disease.