Page 102 - Portuguese Journal - SPORL - Vol 61. Nº1

cutaneous, mucocutaneous, and visceral. of the septum. Concomitantly, an anterior
Mucocutaneous leishmaniasis is the rarest
form and is mainly caused by the species
Leishmania Braziliensis. It may occur as
a primary manifestation of the disease or
secondary to the cutaneous presentation. 1,3,6
The case presented herein is that of a
woman with a previous history of cutaneous
leishmaniasis treated five years ago who was
referred to the otorhinolaryngology (ORL)
clinic due to de novo nasal complaints.
Case description
The patient was a 48-year-old woman who
lived in a rural area and was referred to the
ORL clinic for nasal congestion and self-
limited episodes of epistaxis. She had a
relevant history of type II diabetes mellitus
and cutaneous leishmaniasis (Leishmania
tropica) diagnosed in 2015, which was treated
with oral itraconazole (600 mg once/day for
28 days), with lesion resolution. She did not
have a history of nasal trauma or chronic
rhinosinusitis. She denied having recently
travelled abroad or before the diagnosis of
cutaneous leishmaniasis.
Objective examination showed erythematous
lesions, infiltrating the sides of the nose,
columella, and nasal vestibule (Figure 1). Nasal
endoscopy also showed thick, erythematous
plaque lesions with scabs in the anterior region
Figure 1
Before treatment. Well demarcated erythema in
the middle third of the face, homogeneous at the
level of the sides of the nose, nasal columella, and
nasal philtrum
102 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery
septal perforation of approximately 0.50.5
cm was observed in the Cottle areas 2 and 3
(Figure 2). Neck palpation was normal, as was
7
the remaining objective ORL examination.
There were no erythematous lesions at other
sites of the body.
Figure 2
Nasal endoscopy of the right nasal cavity. Multiple
small lesions, with erythematous borders can be
seen
Blood tests showed mild lymphopenia
(0.7910 /L), glycated hemoglobin of 6.9%, and
9
sedimentation rate of 7 mm/h. The results of
tests for autoimmunity, vasculitis, VDRL, and
HIV serology were negative.
Computed tomography (CT) of the
paranasal sinuses showed discontinuity of
the cartilaginous portion of the anterior
region of the nasal septum and thickening
of the soft tissues of the septal mucosa.
Abdominal CT did not show any relevant
changes. Skin and endonasal biopsies were
performed and the histological examination
showed a dense inflammatory infiltrate
with numerous histiocytes containing
intracytoplasmic structures compatible
with Leishman-Donovan bodies. The result
of the polymerase chain reaction assay was
compatible with a diagnosis of leishmaniasis.
The patient was hospitalized for treatment
with amphotericin B (4 mg/kg, IV). Three
weeks after the treatment, there was no