Painful nasal obstruction: Differential diagnosis

Leishmaniasis is an infectious disease caused by intracellular protozoan parasites. It occurs mainly in Asia, Africa as well as in South- and Central America. The disease is transmitted by the bite of certain types of sandflies. Depending on the subtype and the immune status of the infected person there are 3 main types of leishmaniasis: cutaneous-, mucocutaneous-, and visceral leishmaniasis. Cutaneous leishmaniasis is the most common. Over 90% of the infections are caused by leishmania braziliensis. The incubation period is approximately 2 weeks to several years. The disease is tending to spread in the northern territories.

We report the case of a 23-year-old patient complaining of odynophagia, nasal obstruction and nasal pain. An endoscopic examination showed a destruction of the nasal septum with a constriction of both nasal cavities. The pharynx and the larynx were full of granulomas and ulcera with reddened mucous membranes.

With an endonasal biopsy, Leishmania braziliensis could be detected via PCR and sequence analysis. A therapy including Miltefosin and Pentamidin was started. Within a few weeks there was a significant improvement of the findings and the complaints. In 2015 the patient has already been suffering from cutaneous leishmaniasis during a stay in Brazil and was treated there with Amphotericin B for a few weeks.

Mucocutaneous leishmaniasis is a rare infection in Germany. Due to the incubation period of weeks up to 10 years an accurate diagnosis is often difficult. Therefore, an interdisciplinary cooperation between the department of ears, nose and throat as well as the department of microbiology, the department of infectiology and optionally the tropical medicine is very important.

Publication History

Publication Date:
12 June 2019 (online)