Oral leishmaniasis in a HIV‐positive patient. Report of a case involving the palate

Abstract

Leishmaniasis is a parasitic disease caused by a protozoon (Leishmania), with different clinical forms that are endemic in certain countries. The association of this disease in patients who are seropositive to human immunodeficiency virus (HIV) has recently been described. Leishmaniasis can develop in any stage of HIV infection, although the clinical manifestations - and hence the diagnosis - tend to coincide with the periods of maximum immune depression. We present the case of a HIV-positive, ex-intravenous drug abuser (in stage B2 of the CDC, 1992) with concomitant hepatitis C infection who presented with palatinal pain and bleeding for the past 2 months. Exploration revealed a vegetating tumoration of the hard palate. Hematoxylin-eosin and Giemsa staining of the biopsy confirmed the diagnosis of leishmaniasis. The definitive diagnosis was mucocutaneous leishmaniasis (MCL), for a bone marrow aspirate proved negative, and no further lesions could be established. The patient was treated with meglumine antimoniate (Glucantime), followed by improvement of the lesions.

Oral leishmaniasis: a clinicopathological study of 11 cases

“…The visceral form of leishmaniasis is caused mainly by L. infantum and L. donovani , which is endemic in the western Mediterranean. Cutaneous leishmaniasis is caused by L. tropica or L. major and the mucocutaneous variant is mainly due to L. (V.) braziliensis , but also L. panamensis , L. guyanensis and L. (L.) amazonensis , which is endemic in South America (Herwaldt, 1999; Milian et al , 2002). Leishmania (L.) amazonensis is responsible for the so‐called New World (American) cutaneous leishmaniasis (Herwaldt, 1999); however it had also been implicated in non‐cutaneous forms of the disease such as mucosal, visceral, and post‐kala‐azar dermal leishmaniasis (Abreu‐Silva et al , 2003).…”

“…There are about 24 infective Leishmania species, however single specie can produce more than one clinical form of the disease, and each form can be caused by multiple species (Aliaga et al , 2003). In endemic regions the protozoa may persist as an asymptomatic parasite for years, and situations of cellular immune suppression can contribute to induce the development of clinical manifestations (Milian et al , 2002).…”

“…Oral lesions usually appear as ulceration in the hard or soft palate. However, they can affect any site and also may present as exophytic, nodular and indurated lesions (Vazquez‐Piñeiro et al , 1998; Milian et al , 2002). Isolated leishmaniasis in the tongue of immunocompetent individuals is extremely rare (Habibzadeh et al , 2005).…”

Case report: Leishmaniasis in the tongue presenting as an SCC

“…The protozoa may persist as an asymptomatic parasite for years, and situations of immune suppression can cause clinical manifestations to develop. The tongue and oral mucosa are the most affected sites in the head and neck region. However, there is a wide spectrum of clinical manifestations.…”

A case of mucosal leishmaniasis of the tongue in a kidney transplant recipient

“…The incidence of leishmaniasis as an opportunistic disease has increased in recent years due to the growing number of patients with immune depression secondary to chronic diseases, neoplasms, transplants, immunosuppressive treatments, and HIV infection 9,10 …”