Leishmaniasis of the upper aerodigestive tract: A lesson for pathologists

Abstract

Primary mucosal leishmaniasis (ML) is relatively rare. The upper aerodigestive tract (UADT) is prone to ML in endemic areas and in immunocompromised patients. ML is gaining noticeable occurrence in non-endemic countries because of travel. Chronic secondary ML in non-endemic areas could be overlooked by the unwary clinicians and histologically missed by pathologists. This might result in erroneous treatment, acute exacerbation, disseminated disease and hindered recovery due to delayed diagnosis and therapy. We report a case of a 49-year-old man, who presented with dysphagia and hoarseness of the voice for one year. Clinically, leishmaniasis was unsuspected and scant amastigotes were histologically missed in two consecutive biopsies of the UADT. The patient was treated with corticosteroids for chronic inflammation and lymphoid hyperplasia, which resulted in worsening condition and a disseminated disease. The third biopsy showed numerous amastigotes. The diagnosis was flaring of ML with dissemination in a patient with chronic disease due to iatrogenic immunosuppression. He was treated with amphotericin B with incomplete recovery.