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Severe mucosal leishmaniasis with torpid and fatal evolution.

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Mucosal leishmaniasis presents a diagnostic and treatment challenge, often following cutaneous leishmaniasis. This case highlights a severe, neglected progression leading to fatal sepsis.

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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.