ABSTRACT
Leishmaniosis is a chronic parasitic disease, which in Argentina is mainly caused by protozoa belonging to the Leishmania (Viannia) braziliensis complex, leading to cutaneous and mucosal pathologies. We report a rare case of laryngeal leishmaniosis in a 29 year-old man from Jujuy province, Argentina, who had been misdiagnosed with other pathologies, carrying this infectious disease for about 20 years. During 2008, the patient was admitted with complaints of progressive hoarseness of the voice and dyspnea. He also reported having received tuberculostatics, antifungal and corticosteroids treatments since 2002. Different biopsies and direct laryngoscopic exams revealed inespecific granulomatous larynx, TBC-related laryngitis, laryngitis related to Histoplasma infection, extra-nodal Natural Killer-cell lymphoma. Finally, the patient was evaluated at the University Hospital and the final diagnosis was: granulomatous larynx, intra and extra-cytoplasmic Leishmania spp amastigotes, negative for TBC and Histoplasma cultures, and chronic laryngitis related to Leishmania infection, according to the laryngeal endoscopy, microbiological and histopathological exams, respectively. The patient received pentavalent antimonial treatment and his condition improved after 2 months of follow-up. Primary laryngeal leishmaniosis is rare and this localization does not belong to the most prevalent mucosal leishmaniosis. However, this parasitic disease warrants special concern, especially in patients who received prolonged corticosteroid treatments, in order to avoid a misdiagnosis of this disease.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Diagnostic Errors , Laryngitis/diagnosis , Leishmaniasis, Mucocutaneous/diagnosis , Adrenal Cortex Hormones/adverse effects , Adult , Antiprotozoal Agents/therapeutic use , Biopsy , Diagnosis, Differential , Granuloma/diagnosis , Granuloma/drug therapy , Granuloma/immunology , Granuloma/parasitology , Histoplasmosis/diagnosis , Humans , Immunocompetence , Laryngeal Neoplasms/diagnosis , Laryngitis/drug therapy , Laryngitis/immunology , Laryngitis/parasitology , Laryngitis/pathology , Laryngoscopy , Leishmania braziliensis/isolation & purification , Leishmaniasis, Mucocutaneous/drug therapy , Leishmaniasis, Mucocutaneous/microbiology , Leishmaniasis, Mucocutaneous/pathology , Lymphoma, Extranodal NK-T-Cell/diagnosis , Male , Recurrence , Staining and Labeling , Tuberculosis, Laryngeal/diagnosisABSTRACT
El rol de los hongos filamentosos hilalinos no dermatofitos, como agentes causales de onicomicosis, ha sido documentado en las últimas tres décadas por diferentes autores y son considerados oportunistas emergentes. El objetivo de este trabajo es presentar un caso de onicomicosis producido por Acremonium kiliense, cuya evolución fue estudiada. Se presentó al laboratorio de micología un paciente de 18 años de edad de sexo femenino con traumatismo en la uña del primer dedo del pie derecho. Se tomaron muestras seriadas de la lesión para la observación microscópica directa con OHK 40% p/v y para cultivos en Agar Sabouraud, Agar Lactrimel y DTM (medio selectivo para dermatofitos) y con las colonias recuperadas se efectuaron microcultivos. Se implementó tratamiento con ciclopirox laca al 8% combinado al principio con Itraconazol vía oral (100 mg/día), con buena evolución. Es importante tener en cuenta a estos hongos oportunistas como agentes etiológicos potenciales de micosis ungueales, en especial en pacientes inmunodeprimidos, ya que la afección ungueal puede ser la puerta de entrada para la diseminación de la infección.
The role of non-dermatophytic hyaline filamentous fungi as agents of onychomycosis has been documented in the last three decades by different authors, who have considered these fungi emerging opportunists. A 18-year-old female patient with trauma to the first toenail of the right foot came to the mycology laboratory. Serial samples of the lesion were collected for direct microscopic observation using 40% (w/v) potassium hydroxide (KOH) and for culture in Sabouraud agar, Lactrimel agar and DTM (dermatophyte selective medium). Microcultures were grown from the colonies recovered. Treatment with 8% ciclopirox nail lacquer, combined at the beginning with oral administration of itraconazole (100 mg a day), was implemented with good evolution. It is important to consider these opportunist fungi as potential etiological agents for nail mycosis, specially in immunosuppressed patients, since nail disease can be the entry point for the spread of infections.
