Document resource
A man in his early 60s presented with a four year history of an erythematous and erosive lesion to the left nose and upper lip (fig 1). The lesion was not tender or pruritic. It was associated with intermittent purulent discharge and had gradually progressed despite treatment with topical corticosteroids. The patient reported progressive nasal congestion. Systemic examination was unremarkable, with no evidence of hepatosplenomegaly, lymphadenopathy, or cutaneous hyperpigmentation. Laboratory test results showed normal complete blood count, normal hepatic and renal function, and negative HIV serology. Nasal endoscopy demonstrated mucosal erosion. Nasopharyngeal biopsy showed lymphoid tissue hyperplasia and granulomatous inflammation. Target enriched next generation sequencing detected Leishmania infantum (read counts: 374 and 495), and results from subsequent rK39 serological testing were positive, confirming the diagnosis of mucocutaneous leishmaniasis. The patient was treated with sodium stibogluconate, resulting in complete healing without recurrence on follow-up 10 months after treatment.