Mucosal leishmaniasis in Adult
See also in: Oral Mucosal LesionAlerts and Notices
Synopsis
The risk factors for ML are poorly understood but include both parasite and host immunity factors. Even what apparently is the same leishmanial species is not necessarily associated with the same risk for ML in different countries. For example, L (V) braziliensis infection in Brazil and Peru more commonly results in ML than does infection with this same species in Guatemala. Because ML is due to parasitic spread from the skin, most patients who develop ML did not receive optimal therapy for NWCL. In some settings, the risk for ML in patients not optimally treated for NWCL may be approximately 13%. Some patients do not recall a history of NWCL and do not have scars suggestive of prior cutaneous infection. Studies have also shown an increased risk of ML that correlates with male sex, age (specifically young adults), malnutrition, and duration of a primary NWCL ulcer of more than 4 months.
Usually, ML is first evident in the nasal mucosa (sometimes in the mouth) and appears years after the initial cutaneous lesions. It may present early on as nasal stuffiness, discharge, blockage, or epistaxis. If untreated, progressive, disfiguring, naso-oropharyngeal destruction may follow, and in some cases, the pharynx and other airway structures (eg, epiglottis, trachea, larynx) may be involved. Rarely, airway compromise or aspiration pneumonia may lead to death.
Patients with a history of NWCL, however remote, caused by relevant leishmanial species should be evaluated for ML with periodic naso-oropharyngeal examinations until 2 years following NWCL treatment.
Codes
ICD10CM:B55.2 – Mucocutaneous leishmaniasis
SNOMEDCT:
403135004 – American mucocutaneous leishmaniasis
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Differential Diagnosis & Pitfalls
- Herpes simplex virus
- Paracoccidioidomycosis
- Primary syphilis
- Histoplasmosis
- Tertiary yaws (gangosa, gondou)
- Rhinoscleroma
- Rhinosporidiosis
- Leprosy
- Tertiary syphilis
- Sarcoidosis
- Lethal midline granuloma
- Basal cell carcinoma
- Tuberculosis
- Granulomatosis with polyangiitis
- NK/T-cell lymphoma
- Nasal cocaine use
- Noma
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Last Reviewed:05/05/2021
Last Updated:05/12/2021
Last Updated:05/12/2021
Mucosal leishmaniasis in Adult
See also in: Oral Mucosal Lesion