title: Laryngeal leishmaniasis in a patient taking inhaled corticosteroids.
abstract: We present a case of a man in his late 60s, who had spent 3-4 months of the year in rural Spain, presenting with intermittent hoarseness of voice. He had a background of asthma and bronchiectasis, and was taking inhaled corticosteroids. His dysphonia was initially managed as bronchiectasis with little improvement. Bronchoscopy revealed a cystic lesion on his left vocal fold, and tissue biopsy revealed Leishmania amastigotes. This confirmed a diagnosis of laryngeal leishmaniasis. We propose that this is likely secondary to his inhaled corticosteroid therapy. The infection was treated with a 30-day course of miltefosine, and at most recent follow-up the patient was deemed free from leishmanial infection.
authors.affiliation: Department of Intensive Care Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
authors.forename: Rachel Margaret
authors.initials: RM
authors.lastname: Roberts
authors.affiliation: Department of Respiratory Medicine, Warwick Hospital, Warwick, UK.
authors.forename: Jayanta
authors.initials: J
authors.lastname: Mukherjee
authors.affiliation: Warwick Hospital, Warwick, UK.
authors.forename: David
authors.initials: D
authors.lastname: Phillips
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000627:therapeutic use*; D000368:Aged; D000932:Antiemetics / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D001999:Bronchoscopy / Q000379:methods; D055154:Dysphonia / Q000188:drug therapy / Q000469:parasitology / Q000503:physiopathology; D006685:Hoarseness / Q000188:drug therapy / Q000469:parasitology / Q000503:physiopathology; D006801:Humans; D007818:Laryngeal Diseases / Q000188:drug therapy / Q000469:parasitology* / Q000503:physiopathology; D007896:Leishmaniasis / Q000175:diagnosis* / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D010767:Phosphorylcholine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011346:Prochlorperazine / Q000627:therapeutic use; D013030:Spain; D014195:Travel; D016896:Treatment Outcome; D014827:Vocal Cords
chemical_list: D000305:Adrenal Cortex Hormones; D000932:Antiemetics; D000981:Antiprotozoal Agents; D010767:Phosphorylcholine; C039128:miltefosine; D011346:Prochlorperazine