Relapsing Nasal Septal Leishmaniasis: Lessons in Long-Term Multidisciplinary Management Case Report

Area of Science:

• Infectious Diseases
• Parasitology
• Tropical Medicine

Background:

• Mucosal leishmaniasis (ML) is a rare, destructive, and recurrent protozoal infection caused by Leishmania species, most commonly Leishmania braziliensis.
• ML can develop months to years after initial cutaneous leishmaniasis (CL), potentially leading to severe mucosal destruction if untreated.

Purpose of the Study:

• To present a unique case of recurrent mucosal leishmaniasis caused by Leishmania braziliensis.
• To emphasize the importance of long-term surveillance and multidisciplinary management in preventing mucosal destruction and managing relapses.

Main Methods:

• A case presentation of a 48-year-old male with a history of CL treated with meglumine antimoniate, who developed ML.
• Initial treatment with fluconazole was ineffective; miltefosine led to resolution, followed by reconstructive surgeries.
• Recurrence 38 months later confirmed L. braziliensis infection, treated successfully with amphotericin B.

Main Results:

• The case demonstrates the relapsing nature of ML and its potential for extensive mucosal damage.
• A significant delay in recurrence was observed after miltefosine therapy.
• Successful management involved a combination of systemic therapies and reconstructive surgery.

Conclusions:

• Early recognition, timely systemic therapy, and structured multidisciplinary care are critical for managing ML and preventing mucosal destruction.
• Vigilant long-term follow-up is essential due to the high recurrence rate of L. braziliensis infections.
• Extended surveillance may be necessary to detect late relapses, especially with newer therapeutic agents.