Isolated laryngeal leishmaniasis mimicking laryngeal carcinoma: a case report

Laryngeal leishmaniasis is an extremely uncommon presentation of leishmaniasis that can clinically and radiologically mimic malignant tumors, posing a significant diagnostic challenge, especially in endemic regions.

We report the case of a 61-year-old North African man with a history of chronic smoking, who presented with progressive exertional dyspnea evolving over one year, later associated with inspiratory stridor and dysphonia. There was no history of recent hospitalization, intubation, prolonged antibiotic use, or intensive care stay. Due to worsening airway obstruction, an emergency tracheostomy was performed two months prior to presentation. Clinical examination and imaging revealed a locally advanced pharyngolaryngeal mass centered on the supraglottic region, appearing infiltrative, exophytic, and lytic, highly suggestive of malignancy. Three successive direct laryngoscopies with biopsies were performed, all negative for malignancy, showing intracellular microorganisms within an inflammatory infiltrate. Further investigations, including serologies for syphilis and human immunodeficiency virus (HIV), as well as tuberculosis testing (GeneXpert), were negative. Given the patient's residence in a known leishmaniasis-endemic region in southern Morocco, leishmaniasis was suspected. Serology confirmed the diagnosis of laryngeal leishmaniasis. The patient was treated with amphotericin B, including both induction and maintenance doses, resulting in clinical improvement and partial endoscopic regression of the lesion.

Laryngeal leishmaniasis, though rare, should be considered in the differential diagnosis of atypical laryngeal masses, particularly in patients from endemic areas, to avoid misdiagnosis and unnecessary aggressive surgical procedures.