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LETTER TO EDITOR
Year : 2014  |  Volume : 51  |  Issue : 3  |  Page : 401-402
 

Oral cutaneous leishmaniasis mimicking carcinoma of tongue: A case report


Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India

Date of Web Publication10-Dec-2014

Correspondence Address:
Kumar Prabhash
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.146789

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How to cite this article:
Joshi A, Dhumal S B, Noronha V, Bonda A, Pandey A, Raja Manickam D K, Prabhash K. Oral cutaneous leishmaniasis mimicking carcinoma of tongue: A case report. Indian J Cancer 2014;51:401-2

How to cite this URL:
Joshi A, Dhumal S B, Noronha V, Bonda A, Pandey A, Raja Manickam D K, Prabhash K. Oral cutaneous leishmaniasis mimicking carcinoma of tongue: A case report. Indian J Cancer [serial online] 2014 [cited 2019 Sep 21];51:401-2. Available from: http://www.indianjcancer.com/text.asp?2014/51/3/401/146789


Sir,

Leishmaniasis is an arthropod borne zoonosis transmitted via female sandflies. It is broadly grouped into cutaneous, mucocutaneous and visceral leishmaniasis as per the clinical manifestations of each group. [1] PKDL - Post Kala Azar Dermal Leishmaniasis is a sequel of visceral leishmaniasis caused by L. donovani and usually presents two years after the visceral leishmaniasis. It presents as hypopigmented macules/indurations anywhere in the body usually on the upper trunk. However, there are several documented unusual presentations of cutaneous leishmaniasis which includes pretibial ulcers, painful nipple swelling in males, unilateral erythema nodosum,ulceroproliferative growth over sternum, painful solitary nasal nodule [2] Other differential diagnosis includes dermatofibrosarcoma protuberans, squamous cell carcinoma,chalazion like ulcers, tuberculous lymphadenopathy,myeloma like Pictures [3] . Here we present a case report of one such patient with past history of leishmaniasis who presented to us with a lesion over the lateral border of the tongue mimicking as carcinoma tongue.

A 52-year-old male patient from Bihar with past history of visceral leishmaniasis treated by Amphotericin B about six years ago, presented to us with a bilateral nodular lesion over the tongue of about 2 × 3 cm on right side and 2 × 2 cm on the left side for past 5 years [Figure 1]. There was a cm sized submental node. His labs were suggestive of hyperglobulinemia, relative monocytosis and leucopenia. The patient's MR imaging showed a soft tissue thickening seen in anterior 2/3rd s of the tongue along the right and left lateral borders with postcontrast enhancement suggestive of chronic inflammation vs carcinoma. Biopsy of both lesions showed rich infiltrate of lymphoid and plasma cells, with T cells (CD3), B cells (CD 20), plasma cells (CD 138). A skin biopsy was done which showed diffuse dense infiltrate of lymphocytes, plasma cells and macrophages involving the upper and mid dermis with semblance of granuloma formation. Nerve, erector pilorum muscle and appendages were spared with Overlying hypertrophic epidermis. A diagnosis of PKDL was made. The patient was managed with Rifampicin and Ketoconazole. After two months of treatment the lesion showed significant reduction in the size with symptomatic improvement as well [Figure 2].
Figure 1: Before treatment

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Figure 2: After treatment

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The diagnosis of PKDL is based on clinical and epidemiological parameters. Demonstration of parasite in the slit smear or by culture of the dermal tissue is considered to be the gold standard. [4] The main factors responsible for the difficulties in arriving at the diagnosis of cutaneous leishmaniasis are presentations mimicking other diseases and the fact that amastigote forms are difficult to detect in several cases of microscopy. However in countries like India, these presentations should be kept in mind more so if the patient belongs to one of the endemic areas.

 
  References Top

1.
World Health Organization. Control of Leishmaniases: Report of the WHO Expert committee Meeting, Geneva. 22-26 March 2010.WHO Technical Report Series 2010;949:1.  Back to cited text no. 1
    
2.
Bari AU, Rahman SB. Many faces of cutaneous leishmaniasis. Indian J Dermatol Venerol Leprol 2008;74:23-7.  Back to cited text no. 2
    
3.
Jombo GT, Gyoh SK. Unusual presentations of cutaneous leishmaniasis in clinical practice and potential challenges in diagnosis: A comprehensive analysis of literature reviews. Asian Pac J Trop Med 2010;3:917-21.  Back to cited text no. 3
    
4.
Singh RP. Observation on dermal leishmanoid in Bihar. Indian J Dermatol 1968;13:59-63.  Back to cited text no. 4
    


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