An Unusual Case of Solitary Oral Leishmaniasis in an Elderly Woman

Abstract

Leishmaniasis is a chronic inflammatory disease caused by a flagellate protozoan from the genus Leishmania, transmitted by an insect vector belonging to either the genus Phlebotomus spp. or Lutzomyia spp. This disease is considered one of the most prevalent infectious diseases worldwide due to its high detection rate and the morbidity it causes. A 70-year-old woman from a low-income background, with no significant medical or drug history and no other general constitutional symptoms, presented with an asymptomatic, exophytic, granulomatous growth that has a reddish hue. The growth is located on the lingual aspect of the mandibular anterior teeth region and has been progressing over the past six months. Radiographic features suggested associated chronic periodontitis along with hyperdense calcified deposits. On excisional biopsy and histopathology, the excised specimen revealed characteristic Leishmania amastigotes and pseudoepitheliomatous hyperplasia. An abdominal ultrasound was advised to rule out any visceral involvement, but no significant findings were observed. The present case is particularly intriguing due to oral mucosal involvement by Leishmania sp. without associated primary visceral or cutaneous lesions, especially given the male predilection (M:F=7:5) and the most common site involved being the posterior palatal region for Leishmaniasis. The present case represents a rare instance. Considering the difficult socio-economic circumstances, the involvement of the World Health Organization (WHO) demonstrates an understanding of the need for collaboration in supporting underprivileged communities.