Hoarseness as the Presenting Symptom of Visceral Leishmaniasis with Muco-Cutaneous Lesions: A Case Report.
AbstractHerein, a 28-year-old man with hoarseness, skin and oral lesions is presented. At the time of admission, the patient had an erythematous plaque on his chin near his lower lip and an erythematous-violaceous plaque on his palate near the open-ing of the pharynx and 20 kg weight lost in last one year. The biopsy of his skin lesions by hematoxylin and eosin staining revealed an infiltration of the dermis by lymphoplasma and histiocytic cells with a loose granuloma formation sugges-tive of leishmaniasis. Biopsy of mucosal lesions revealed Leishman bodies in dermis. PCR was performed on the specimens of skin, bone marrow, mucosa, and saliva, the results were positive. The pathogenic agent was identified as Leishmania major by the nested PCR. Serologic tests including direct agglutination test (DAT) and indirect immunofluorescence test (IFAT) were positive with high titers of anti-L. infantum antibodies (1:102400 versus 1:800, respectively), indicative of visceral involvement. The patient responded to a combination of miltefosine and meglumine antimoniate (Glucantime®). Visceral involvement due to L. major is rarely reported. To the best of our knowledge, probably hoarseness due to L. major has not been previously reported from Iran.
Alborzi A, Pouladfar GR, Ghadimi Moghadam A, Attar A, Drakhshan N, Khosravi Maharlooei M, et al. First molecular-based detection of mucocutaneous leishmaniasis caused by Leishmania major in Iran. J Infect Dev Ctries. 2013;7(5):413-6.
Ziai M, Bowman JE, McMillan CW, Tabatabai M. Leishmaniasis in southern Iran: the occurrence of the three varieties in the same area. Trans R Soc Trop Med Hyg. 1968;62(5):668-71.
Shirian S, Oryan A, Hatam GR, Daneshbod Y. Three Leishmania/L. species--L. infantum, L. major, L. tropica--as causative agents of mucosal leishmaniasis in Iran. Pathog Glob Health. 2013;107(5):267-72.
Daneshbod Y, Oryan A, Davarmanesh M, Shirian S, Negahban S, Aledavood A, et al. Clinical, histopathologic, and cytologic diagnosis of mucosal leishmaniasis and literature review. Arch Pathol Lab Med. 2011;135(4):478-82.
Tiseo D, Tosone G, Conte MC, Scordino F, Mansueto G, Mesolella M, et al. Isolated laryngeal leishmaniasis in an immunocompet-
ent patient: a case report. Infez Med. 2008;16(4):233-5.
Noyes HA, Reyburn H, Bailey JW, Smith D. A nested-PCR-based schizodeme method for identifying Leishmania kinetoplast minicircle classes directly from clinical samples and its application to the study of the epidemiology of Leishmania tropica in Pakistan. J Clin Microbiol. 1998;36(10):2877-81.
Mohebali M, Edrissian G, Nadim A, Hajjaran H, Akhoundi B, Hooshmand B, et al. Application of direct agglutination test (DAT) for the diagnosis and seroepide-miological studies of visceral leishmaniasis in Iran. Iran J Parasitol. 2006;1(1):15-25.
Mohebali M, Fotouhi A, Hooshmand B, Zarei Z, Akhoundi B, Rahnema A, et al. Comparison of miltefosine and meglumine antimoniate for the treatment of zoonotic cutaneous leishmaniasis (ZCL) by a randomized clinical trial in Iran. Acta Tropica. 2007;103(1):33-40.
Mohebali M. Visceral leishmaniasis in Iran: Review of the Epidemiological and Clinical Features. Iran J Parasitol. 2013;8(3):348-58.
Karamian M, Motazedian MH, Mehrabani D, Gholami K. Leishmania major infection in a patient with visceral leishmaniasis: treatment with Amphotericin B. Parasitol Res. 2007;101(5):1431-4.
Gonzalez-Beato MJ, Moyano B, Sanchez C, Gonzalez-Beato MT, Perez-Molina JA, Miralles P, et al. Kaposi's sarcoma-like lesions and other nodules as cutaneous involvement in AIDS-related visceral leishmaniasis. Br J Dermatol. 2000;143(6):1316-8.
Ara M, Maillo C, Peon G, Clavel A, Cuesta J, Grasa MP, et al. Visceral leishmaniasis with cutaneous lesions in a patient infected with human immunodeficiency virus. Br J Dermatol. 1998;139(1):114-7.
Colebunders R, Depraetere K, Verstraeten T, Lambert J, Hauben E, Van Marck E, et al. Unusual cutaneous lesions in two patients with visceral leishmaniasis and HIV infection. J Am Acad Dermatol. 1999;41(5 Pt 2):847-50.
Khorvash F, Naeini AE, Behjati M, Abdi F. Visceral leishmaniasis in a patient with cutaneous lesions, negative Leishman-Donovan bodies and immunological test: A case report. Journal of research in medical sciences. J Res Med Sci. 2011;16(11):1507-10.