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.
A 10-year-old girl was referred to the Dermatology Clinic of Saadi Hospital. The patient had become infected with CL on the left side of her mentum 3 months before. Three weeks prior to referral, the lesion had spread to the mucosal part of the lower lip. The patient improved diffuse severe swelling of the lower lip. On physical examination, erythema, ulceration, and scaling of the left side of the mentum were detected. There was a diffuse swelling cheilitis of the lower lip extra to ulceration and bleeding of the labial mucosa (Fig. ). Giemsa-stained smears and culture were positive. PCR identified the parasite as L. major.