CASE REPORTS   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2012 December;171(6):823-7

Copyright © 2012 EDIZIONI MINERVA MEDICA

language: English

Rare association of laryngeal precancerosis and laryngeal leishmaniasis

Allegra E. ¹, Franco T. ¹, Trapasso S. ¹, Caroleo B. ², Focà A. ³, Amorosi A. ⁴, Garozzo A. ¹

¹ Department of Otolaryngology-Head and Neck Surgery, University of Catanzaro, Catanzaro, Italy; ² Infectious Disease Unit, University of Catanzaro, Catanzaro, Italy; ³ Laboratory of Clinical Microbiology, University of Catanzaro, Catanzaro, Italy; ⁴ Department of Pathology, University of Catanzaro, Catanzaro, Italy

Leishmaniasis is a Mediterranean zoonoses caused by Leishmania protozoa parasites, transmitted by the bite of a sandfly. Leishmaniasis literature deals with primary laryngeal localization and laryngeal infection secondary to reactivation of cutaneous or mucocutaneous leishmaniasis, in immunosuppressed or on therapy with inhaled corticosteroids patients. A 51-year-old man presented to our outpatient clinic complaining of hoarseness for the previous 4 years. Laryngoscopy identified a whitish and vegetating lesion on the left vocal fold and patient was subjected to laryngeal biopsy. Histological examination revealed the presence of mild dysplasia. Patient was then subjected to laryngoscopic monthly checks. A second laryngeal biopsy was performed 3 months later, because of the worsening of dysphonia and the observation of a new leukoplasic lesion. Histological examination identified the presence of Leishmania infantum. Patient was sent to the Infectious Diseases Department, where three skin lesions and mild splenomegaly were identified and a diagnosis of muco-cutaneous leishmaniasis from Leishmania infantum was finally reached. The patient was submitted to liposomal Amphotericin B i.v. therapy and an almost complete remission was achieved. In our case, laryngeal dysplasia led to a careful endoscopic larynx surveillance, which allowed to early identify the second lesion. This lesion was considered an evolution of precancerosis and only histological examination identified the laryngeal localization of Leishmania Infantum. This is the first case of laryngeal leishmaniasis occurring on a dysplasia and although laryngeal localization was not primary, dysphonic symptoms led to the identification of mucocutaneous leishmaniasis, and to the appropriate treatment and healing of the patient.