Laryngeal leishmaniasis: An alternative cause of progressive dysphonia in an older adult on inhaled corticosteroids

Background: Leishmaniasis is a disease caused by an intracellular parasite transmitted to humans by the bite of sandflies. Traditionally, it is regarded as causing cutaneous, muco-cutaneous or visceral disease, depending on the species or parasite and geographic region of infection. Isolated laryngeal leishmaniasis represents a rare diagnosis, especially in patients who have not travelled outside of Europe. Case Report: We outline a case of a 71-year-old British male who presented with a four-year history of progressive dysphonia. He had a past medical history of chronic obstructive pulmonary disease, treated with inhaled corticosteroids, and was an ex-smoker. He had travelled to Greece and Spain, but never outside of Europe. Examination with microlaryngoscopy demonstrated diffuse oedema and erythema of the post-cricoid area and an oedematous and erythematous right vocal cord. Histology demonstrated chronic inflammation and the presence of Leishman-Donovan bodies. Leishmania serology was positive. There was no evidence of cutaneous or visceral leishmaniasis and an HIV antigen/antibody test was negative. He was treated with a 1-week course of intravenous liposomal amphotericin B followed by 28 days of oral fluconazole, resulting in complete resolution of his symptoms on follow-up 6 months later. Conclusion: Muscosal leishmaniasis is a rare but treatable cause of dysphonia in travellers to the Mediterranean region, particularly in those who have a history of smoking or corticosteroid use. Mucosal leishmaniasis is rare in countries with endemic “Old World” Leishmania species, being much commoner in regions with “New World” species, but all have the potential to cause mucosal disease. Therefore, an awareness of the condition is of importance to physicians across all regions of the world, enabling treatment of an otherwise disabling and potentially fatal disease.