Nasal polyps: a predisposing factor for cutaneous leishmaniasis of the lips?

OBJECTIVES

Cutaneous leishmaniasis (CL) of the lips is rare. This study was conducted to investigate findings in patients with this condition.

METHODS

From 2007 to date, we observed 10 patients (nine males and one female), with a median age of 45.2 years (range: 8-77 years), with CL of the lips.

RESULTS

Six of the 10 patients suffered from nasal polyps, three from bronchial asthma, and one from chronic obstructive pulmonary disease (COPD). Three of the patients with nasal polyps also had asthma. Three patients had none of nasal polyps, asthma, or COPD. In all patients with nasal polyps, diagnosis was confirmed by anterior rhinoscopy and nasal endoscopy.

CONCLUSIONS

It is possible that, in patients with nasal polyps, asthma, and COPD, the need to breathe through the mouth rather than the nose facilitates the sting by sandflies. Subjects with nasal polyps living in areas endemic for CL should be warned about the risk for being stung by sandflies on the lips, in addition to other uncovered areas.

Case report: leishmaniasis of the upper lip

We report a case of leishmaniasis localized to the upper lip in a 77-year-old Italian man. The disease was characterized by a severe swelling which involved the right side of the upper lip. The swelling was slightly erythematous with crusts and scaling. Consistency was parenchymatous-hard. The lesion was asymptomatic. Histopathologic examination showed an inflammatory infiltrate consisting of lymphocytes, histiocytes, and plasma cells. Several Leishmania spp. amastigotes were observed in the cytoplasm of macrophages. Cultural examination on Novy-MacNeal-Nicolle medium was positive for Leishmania spp. Polymerase chain reaction was positive for Leishmania infantum. The patient was treated with i.m. N-methylglucamine antimonate, with complete remission in approximately 6 weeks. During follow-up of 9 months, no relapses were observed.

Leishmaniasis cutánea

Leishmaniases are diseases caused by infection by protozoa of the genus Leishmania. Cutaneous leishmaniasis caused by Leishmania infantum is frequent in Spain, especially in certain geographic areas. Diagnosis of cutaneous leishmaniasis is difficult because of the varied symptoms and because making cultures of this parasite is complicated. There are also different therapeutic, medical and surgical options, none of which is fully satisfactory. We review the most significant agents of cutaneous leishmaniasis in Spain.