An 80-year-old male patient, living in a rural area, ex-smoker and social drinker, HIV negative, was referred to the stomatology clinic complaining of lesions on the upper lip, soft and hard palate that had been presented for 9 months, producing severe pain in the affected regions.\nThe patient underwent two biopsies in other clinical settings with inconclusive results. On physical examination, the right side of the upper lip presented an erythematous swelling associated with a granulomatous ulceration of labial mucosa that extended to the hard palate and seemed to infiltrate to the nasal region [Figure –]. No skin involvement was observed. Cervical lymphadenopathy with inflammatory features as swelling, pain and firm consistency was noticed during palpation.\nThe clinical hypothesis of tuberculosis, histoplasmosis and SCC were investigated, and an incisional biopsy was performed under local anesthesia. The patient's medical history recorded no relevant data.\nThe microscopical study evidenced areas of intense diffuse inflammatory infiltrate, with organized areas in the form of granulomas. In addition, the presence of multinucleated giant cells was observed, and a descriptive diagnosis of nonspecific chronic inflammatory process was provided [Figure and ]. Regarding the clinical and histopathological information, the hypothesis of mucocutaneous leishmaniasis was raised, and IDRM test was requested, which confirmed the suspicion. The patient was referred to an infectious diseases specialist to start treatment with Glucantime® (N-methylglucamine antimoniate). The dosage used was 20 mg Sb5 (pentavalent antimonial) +/kg/day intravenously for 30 days. Complete remission of the lesions was observed post treatment and after a follow-up of 12 months the patient remained with no signs of the disease and just a minor cicatricial sequelae.
A 28-year-old man expressed displeasure about a swelling localized to the left side of the upper lip. The patient also stated that the swelling had appeared about 2 months before and that it rapidly enlarged up to the current morphology and size. Clinical examination showed the presence of a swelling which involved the left side of the upper lip. The surface of the swelling was slightly erythematous and irregular, because of the presence of lesion and scaling (Fig. ). Consistency was parenchymatous-hard. With suspicion of mycotic infection, laboratory tests were carried out. Slit dermal smears and culture were positive. PCR characterized the parasite as L. tropica.