[Recidivant laryngeal leishmaniasis: an unusual case in an immunocompetent patient treated with corticosteroids].
Leishmaniosis is a chronic parasitic disease, which in Argentina is mainly caused by protozoa belonging to the Leishmania (Viannia) braziliensis complex, leading to cutaneous and mucosal pathologies. We report a rare case of laryngeal leishmaniosis in a 29 year-old man from Jujuy province, Argentina, who had been misdiagnosed with other pathologies, carrying this infectious disease for about 20 years. During 2008, the patient was admitted with complaints of progressive hoarseness of the voice and dyspnea. He also reported having received tuberculostatics, antifungal and corticosteroids treatments since 2002. Different biopsies and direct laryngoscopic exams revealed inespecific granulomatous larynx, TBC-related laryngitis, laryngitis related to Histoplasma infection, extra-nodal Natural Killer-cell lymphoma. Finally, the patient was evaluated at the University Hospital and the final diagnosis was: granulomatous larynx, intra and extra-cytoplasmic Leishmania spp amastigotes, negative for TBC and Histoplasma cultures, and chronic laryngitis related to Leishmania infection, according to the laryngeal endoscopy, microbiological and histopathological exams, respectively. The patient received pentavalent antimonial treatment and his condition improved after 2 months of follow-up. Primary laryngeal leishmaniosis is rare and this localization does not belong to the most prevalent mucosal leishmaniosis. However, this parasitic disease warrants special concern, especially in patients who received prolonged corticosteroid treatments, in order to avoid a misdiagnosis of this disease.
Casero
R
R
Departamento de Parasitología, Hospital Nacional de Clínicas, Universidad Nacional de Córdoba, Córdoba, Argentina. rodaca@argentina.com
Laconte
L
L
Fraenza
L
L
Iglesias
N
N
Quinteros Greco
C
C
Villablanca
Ml
M
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001706:Biopsy; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D006099:Granuloma / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000469:parasitology; D006660:Histoplasmosis / Q000175:diagnosis; D006801:Humans; D007121:Immunocompetence; D007822:Laryngeal Neoplasms / Q000175:diagnosis; D007827:Laryngitis / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000469:parasitology / Q000473:pathology; D007828:Laryngoscopy; D007892:Leishmania braziliensis / Q000302:isolation & purification; D007897:Leishmaniasis, Mucocutaneous / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D054391:Lymphoma, Extranodal NK-T-Cell / Q000175:diagnosis; D008297:Male; D012008:Recurrence; D013194:Staining and Labeling; D014387:Tuberculosis, Laryngeal / Q000175:diagnosis
D000305:Adrenal Cortex Hormones; D000981:Antiprotozoal Agents