A case of mucosal leishmaniasis: Mimicking intranasal tumor with perforation of septum

A 79-year-old male suffering from nasal congestion was referred to our hospital. Endoscopic examination revealed a hyperemic mass obstructing the left nasal passage. The lesion's surface was smooth. The findings of imaging studies were consistent with a benign tumor despite the erosion and perforation of the septum. The lesion originated from the middle concha and was attached to it with a thin stalk. It was removed easily by endoscopic resection. Histopathology revealed significant infiltration of mononuclear inflammatory cells, mostly lymphocytes and histiocytes, into the edematous subepithelial connective tissue. High-power magnification showed numerous Leishmania amastigotes in the cytoplasm of the histiocytes. A polymerase chain reaction experiment for Leishmania also confirmed the morphological diagnosis. No relapse was observed in the 12 months after surgery and the patient was doing well.

A modification of the transverse forked flap to allow three-dimensional columella reconstruction

The original transverse forked flap is effective in reconstructing the anterior wall of columella in a single stage without leaving a noticeable secondary deformity. A modification was done to allow reconstruction of the lateral walls of columella in addition. This three-dimensional reconstruction will provide enough coverage for a cartilage graft if used. This modification was applied to three patients with columella defects. A costal cartilage graft was used in one of these patients. All flaps survived and donor site scarring was unnoticeable. Elevation of the base of the forked flap allowed using it to reconstruct the anterior wall of columella while sparing the lateral wings to reconstruct the lateral walls of columella.

[Laryngeal leishmaniasis]

Leishmaniasis consists in a zoonotic infection, that means affect animals. Due to the puncture of the female sand fly type Phlebotomus (Ancient World) or Lutzomya (New World) the human being can be also affected. The clinical manifestations are very varied, depending to factors related with host, vector and the proper parasit. In this present work, we expose the three unic cases of Leishmaniasis affecting the larynx, diagnosticated in the sanitary area of Toledo. Due to the specific characteristics that present each case different treatments for each one have been realised, and its results and treatment exposed.

Isolated lingual leishmaniasis

Cutaneous leishmaniasis is endemic in Fars Province, southern Iran. However, mucosal leishmaniasis is extremely uncommon. Herein, we report a patient with isolated lingual leishmaniasis in an immunocompetent 40-year-old man. The lesion was totally excised. The patient was cured completely and is doing well after four years of follow-up, with no medical treatment.

Management of leishmanial osteolytic lesions in a hypothyroid dog by partial tarsal arthrodesis

A five-year-old male boxer, previously diagnosed with leishmaniasis and hypothyroidism, had gradually become unable to bear weight on its left hindlimb. Physical examination revealed a left popliteal lymphadenopathy, mild crepitus, and severe swelling of the left tarsal joint, a radiographic examination of which revealed severe bone destruction of the talus and a periosteal reaction of the calcaneus. Laboratory findings and serological tests suggested an active leishmanial infection, and a Leishmania species was identified by direct cytology of a sample from the osteolytic area and by indirect immunohistochemistry of a bone biopsy. The dog's condition improved when it was treated with meglumine antimonate and allopurinol. Because of the large osteolytic area and the increased use of the affected leg, a partial tarsal arthrodesis was performed to prevent a fracture. Five months after the surgery, the osteolytic area had healed completely and the calcaneus periosteal reaction had disappeared.

Isolated laryngeal leishmaniasis in an immunocompetent patient: successful treatment with surgery

The localization of Leishmania spp. in the larynx is rare but it has recently been described in patients infected by human immunodeficiency virus (HIV). The normal treatment given is antimonials. We describe a case of isolated leishmaniasis in the larynx which was cured by surgery. Our patient was a 47-year-old man who had suffered visceral leishmaniasis in his childhood with no immunosuppression.

Treatment of cutaneous leishmaniasis using a carbon dioxide laser

Use of a carbon dioxide laser to vaporize the local lesions caused by cutaneous leishmaniasis is reported. A total of 108 patients have been treated in this way and followed up. The treatment reduces the management time of patients at least 1.5 times and is followed by satisfactory aesthetic outcomes. No recurrences have been observed among the 82 patients who have been followed up for 7 years.

[Cutaneous leishmaniasis: treatment with cryotherapy and intramuscular injections of meglumine antimonate (glucantime)]

A 37-year-old female patient with cutaneous leishmaniasis of the helix of the left ear is reported. The diagnosis was based on her past history, clinical appearance and histological examination (detection of Leishman-Donovan bodies). Initial cryotherapy failed to cure the lesions completely. Treatment with intramuscular injections of meglumine antimonate (Glucantime) was successful. The discussion focuses on the pathophysiology, diagnosis and therapy.

Cryotherapy in acute cutaneous leishmaniasis

Fourteen patients with acute cutaneous leishmaniasis entered a study testing the efficacy of liquid nitrogen. All lesions were cured clinically and protozoologically within 3-8 weeks, without noticeable scarring. The patients did not experience adverse side effects, and there was no relapse 4 months after cessation of therapy. The results of this study indicate that cryotherapy is a safe and effective method for treating cutaneous leishmaniasis.

Early surgical treatment of cutaneous leishmaniasis

Cutaneous leishmaniasis, treated or untreated, is known to leave disfiguring scars. These scars are usually on exposed parts, for which plastic surgery may be required. The present work deals with the treatment of cutaneous leishmaniasis using surgical techniques from the onset. In 20 patients, 35 lesions were excised down to the deep fascia. To cover the resulting defect, subcuticular sutures were used in 7 small lesions. Dufourmental (LLL flap) and Limberg flaps were used in 23 lesions of moderate size. Free grafting was resorted to in five large lesions. Using these techniques, morbidity was reduced and cosmetic results were satisfactory.

Cryosurgery in cutaneous leishmaniasis

Thirty patients with cutaneous leishmaniasis were treated with cryotherapy using a CO2 cryomachine and all were cured without noticeable scarring within 4-5 weeks, with no relapse. Histopathological examination showed that cryotherapy eradicated all parasites in less than 1 hour. Leishmania tropica, L. ethiopica and L. brasiliensis are all markedly thermosensitive and thus cryotherapy seems parasiticidal to all types. Adequate cryotreatment of cutaneous leishmaniasis will preclude the development of mucocutaneous extension, and its use in mucocutaneous disease is also recommended.

Cutaneous leishmaniasis: surgical management of a case with unusual clinical and histological features

Our case of cutaneous leishmaniasis clinically resembles the atypical form "infiltrees en nappes" that was described by Photinos in 1930. A subsequent biopsy of the lesion was performed more than one year after its onset and after a full course of stibogluconate sodium and the specimen showed multiple organisms in multinucleated giant cells as well as in histiocytes. Electrodesiccation and curettage of the lesion resulted in complete healing with minimal scarring.