Leishmaniasis of glans penis

Abstract

BackgroundLeishmaniasis is an important protozoan disease. In the Americas it is produced by several species of the genus Leishmania, transmitted by sand flies of the genus Lutzomyia. Disease spectrum ranges from cutaneous ulceration to more serious involvement of oronasal mucosa that may progress to destruction of central structures of the face and to the life-threatening visceral forms. Leishmania Viannia braziliensis is the most widespread species in Brazil and is often associated with mucosal involvement. Cutaneous lesions are commonly localised in uncovered areas of the body. Genital lesions are rare.Materials and methodsA patient with an ulcerated lesion of the glans penis, followed subsequently by mucosal lesions of the nasal cavity and palate, is presented. Diagnostic procedures were: leishmanin skin test (Montenegro's test) and biopsy of the ulcer border processed for histopathological examination and culture in NNN medium.ResultsLeishmanin skin test was positive. Histopathology showed a granulomatous infiltrate containing some parasites. Culture was positive for Leishmania sp., and was later identified by zymodeme analysis and monoclonal antibodies as L.(V.) braziliensis. The patient was treated with pentavalent antimony at the dose of 10 (mg/kg)/day for 30 days and the lesions healed.Comments and conclusionsIn men, especially over 50 years of age, ulceration of the glans penis is highly suggestive of carcinoma. Precise differential diagnosis is imperative. A lesion, such as the one reported, may cause diagnostic difficulties when it presents in countries different from the source, where the condition is very uncommon. This is increasingly frequent in the current era of widespread air travel.