An 8-year-old girl presented to the Leishmaniasis research laboratory of the Fajr Health Center with complaint of wound on her upper lip. The lesion started 3 months prior as a small nodule in the center of the upper lip which slowly enlarged over a few weeks and then ulcerated. Clinical examination showed an indurated, crusted, and scaled necrotic ulcer with swelling on the midline of the upper lip, extending to the vermilion. There was purulent discharge from the lesion (Fig. f). With suspicion of cheilitis granulomatosa, slit dermal scraping, culture and PCR were performed. Giemsa-stained smear and culture were positive. PCR portrayed the parasite as L. major.
A 62-year-old male patient, rural worker, smoker, and chronic alcohol user, HIV negative, was referred to the stomatology clinic with upper lip and upper alveolar ridge lesions present for 2 months. During anamnesis, sudden weight loss was reported. Medical history recorded no other important data. Extraoral physical examination showed a cutaneous lesion in the left thigh region [] and along with ulcerated lesions of the nasal mucosa. Cervical lymphadenopathy was undetected on palpation.\nPhysical intraoral examination revealed ulcerated and irregular lesions in the mucosa of upper alveolar ridge and palate [Figure and ]. An incisional biopsy was performed under local anesthesia considering a differential diagnosis with paracoccidioidomycosis, tuberculosis and leukemia.\nSerologies for histoplasmosis and toxoplasmosis were subsequently requested, both resulting in non-reactive antibodies. Therefore, mucocutaneous leishmaniasis was suspected. Histopathologic data showed a non-specific chronic inflammatory process. Immunohistochemistry procedures revealed cells positive for CD68 and Leishmania antigen [Figure and ]. In addition, the positivity of the IDRM test proved the hypothesis. Treatment, therapeutic response and follow-up of this patient were similar to those cited for the previous patient.