ABSTRACT
Introduction: Leishmaniasis is classified into three clinical presentations: visceral, coetaneous and mucocutaneous. The latter is usually secondary to hematogenous spread after months or years of skin infection and can manifest as infiltrative lesions, ulcerated or vegetating in nose, pharynx, larynx and mouth, associated or not with ganglionics infarction. Laryngeal involvement is part of the differential diagnosis of lesions in this topography as nonspecific chronic laryngitis, granulomatosis and even tumors of the upper aerodigestive tract presenting atypical evolution. Sometimes it is difficult for the correct diagnosis of Leishmaniasis, with description of cases in the literature were conducted improperly. Objective: The objective of this study is to report a case of laryngeal Leishmaniasis addressing the difficulty of diagnosis, complications and treatment applied. Case Report: A patient with pain throat, dysphagia, odynophagia, dysphonia and weight loss, with no improvement with symptomatic medication. At telelaringoscopy, infiltrative lesion showed nodular supraglottis. He underwent a tracheotomy for airway obstruction and biopsy with immunohistochemical study for a definitive diagnosis of laryngeal Leishmaniasis. The patient was referred to the infectious diseases that initiated treatment with N-methylglucamine antimoniate with satisfactory response to therapy. Final Comments: Faced with a clinical suspicion of granulomatous diseases, it is essential to follow protocol laboratory evaluation associated with histological injury, to get a precise definition etiological without prolonging the time of diagnosis. Medical treatment for mucosal Leishmaniasis, recommended by the World Health Organization, was adequate in the case of laryngeal disorders, with complete resolution of symptoms...
Subject(s)
Humans , Male , Middle Aged , Diagnosis, Differential , Dysphonia/etiology , Granulomatous Disease, Chronic/diagnosis , Follow-Up Studies , Larynx/surgery , Larynx/pathology , Leishmaniasis, Mucocutaneous/diagnosis , Leishmaniasis, Mucocutaneous/pathology , Preoperative Period , Deglutition Disorders/etiologyABSTRACT
INTRODUÇÃO: A sarcoidose laríngea é uma doença granulomatosa que representa um desafio em relação ao diagnóstico e o tratamento. MÉTODO: Nesta revisão são abordados todos os aspectos da doença, incluindo etiologia, manifestações clínicas em adultos e crianças, diagnóstico e tratamento, a partir da base de dados Medline, Lilacs e Scielo, incluindo-se artigos de língua inglesa e portuguesa publicados no período de 1973 a 2008. COMENTÁRIOS FINAIS: Apesar dos avanços ocorridos na investigação e tratamento da sarcoidose, é uma doença que ainda se mantém sem etiologia e fisiopatologia definidas, constituindo um diagnóstico de exclusão pela ausência de exames específicos e por sua provável origem multifatorial. O acometimento laríngeo, apesar de raro, é suspeitado principalmente diante de história prévia de sarcoidose sistêmica, e a pesquisa dos diagnósticos diferenciais deve ser extensa para não passarem desapercebidas doenças graves como neoplasias malignas.
INTRODUCTION: Laryngeal sarcoidosis is a granulomatous disease representing a challenge as regards diagnosis and treatment. METHOD: In this review, all aspects of the disease are involved, including etiology, clinical manifestations in adults and children, diagnosis, and treatment, by searching through Medline, Lilacs and Scielo databases, as well as English and Portuguese articles published from 1973 to 2008. FINAL COMMENTS: Despite the breakthroughs in its diagnosis and treatment, sarcoidosis is a disease that remains without a clear etiology and physiopathology, becoming an exclusion diagnosis due to both the lack of precise exams and its likely multifactor background. Laryngeal impairment, however infrequent, is a suspicion mainly when there is a precedent history of systemic sarcoidosis, and the research for differentiated diagnosis must be wide-ranging so as to prevent severe diseases like malign neoplasia from being unnoticed.