Severe mucosal leishmaniasis with torpid and fatal evolution

Area of Science:

• Infectious Diseases
• Dermatology
• Parasitology

Background:

• Mucosal leishmaniasis is a severe manifestation of Leishmania infection.
• It often follows cutaneous leishmaniasis with a significant latency period.
• Diagnosis and treatment can be challenging, leading to potential complications.

Observation:

• A patient with a history of untreated cutaneous leishmaniasis developed severe mucosal leishmaniasis.
• The condition evolved over 9 months, causing facial necrosis, eyeball destruction, and nasal bone exposure.
• The patient presented with chronic anemia, lymphopenia, and neutrophilia.

Findings:

• The patient had co-infections with fungi (yeasts and hyphae) and multidrug-resistant Gram-negative bacteria (Proteus mirabilis, Escherichia coli).
• These co-infections led to sepsis.
• Despite prior incomplete treatment with antimonials and amphotericin B, the disease progressed.

Implications:

• This case underscores the importance of timely and complete treatment for cutaneous leishmaniasis to prevent mucosal progression.
• Highlights the critical role of managing co-infections in immunocompromised patients.
• Emphasizes the potential for severe morbidity and mortality in neglected leishmaniasis cases.