Mucocutaneous Leishmaniasis: clinical markers in presumptive diagnosis

Mucocutaneous Leishmaniasis (ML) can lead to serious sequela; however, early diagnosis can prevent complications.

To evaluate clinical markers for the early diagnosis of ML.

A series study of 21 cases of ML, which were evaluated through clinical interview, nasal endoscopy, biopsy and the Montenegro test.

A skin scar and previous diagnosis of cutaneous leishmaniasis (CL) were reported in 8(38%) patients, and 13(62%) of them denied having had previous CL and had no scar. Nasal/oral symptom onset until the ML diagnosis varied from 5 months to 20 years, mean value of 6 years. In the Montenegro test, the average size of the papule was 14.5 mm, which did not correlate with disease duration (p=0.87). The nose was the most often involved site and the extension of the injured mucosa did not correlate with disease duration. The parasite was found in 2 (9.52%) biopsy specimens.

ML diagnosis was late. Finding the parasite in the mucosa, cutaneous scar and/or previous diagnosis of CL were not clinical markers for ML. ML diagnosis must be based on the Montenegro test, chronic nasal and/or oral discharge and histological findings ruling out other granulomatous diseases.