Leishmaniasis of the lips mimicking a mycotic infection

A 24 years old German man was complaining of painful ulcers with infiltrati on of the lips without alteration of the oral mucosa and swelling of the re gional lymph nodes. Three months earlier he had visited Israel, Italy Roman ia and Bulgaria. He was treated with penicillin, doxycyclin, ciprofloxacin, itraconazole and prednisolone after detection of Candida spec. and staphyl ococci in another town without any effect. The smear and biopsy were sent t o the Robert Koch Institute Berlin. Giemsa stain by phase contrast light mi croscopy with oil immersion showed extracellular amastigote leishmaniae wit h clearly stained kinetoplasts. Leishmania major could be detected ly PCR i nvestigation. The ISE was elevated, other investigations of the blood and f rom the lips were inconspicuous. The ulcers healed promptly under the treat ment with Pentostam (antimony derivative) 0,1 ml/kg body weight i.m. for 12 days and 15% Paromomycin ointment.