LEISHMANIASIS OF GLANS-PENIS

Background Leishmaniasis is an important protozoan disease. Ln the Ame ricas it is produced by several species of the genus Leishmania, trans mitted by sand flies of the genus Lutzomyia. Disease spectrum ranges f rom cutaneous ulceration to more serious involvement of oronasal mucos a that may progress to destruction of central structures of the face a nd to the life-threatening visceral forms. Leishmania Viannia brazilie nsis is the most widespread species in Brazil and is often associated with mucosal involvement. Cutaneous lesions are commonly localised in uncovered areas of the body. Genital lesions are rare. Materials and m ethods A patient with an ulcerated lesion of the glans penis, followed subsequently by mucosal lesions of the nasal cavity and palate, is pr esented. Diagnostic procedures were: leishmanin skin test (Montenegro' s test) and biopsy of the ulcer border processed for histopathological examination and culture in NNN medium. Results Leishmanin skin test w as positive. Histopathology showed a granulomatous infiltrate containi ng some parasites. Culture was positive for Leishmania sp., and was la ter identified by zymodeme analysis and monoclonal antibodies as L.(V. ) braziliensis. The patient was treated with pentavalent antimony at t he dose of 10 (mg/kg)/day for 30 days and the lesions healed. Comments and conclusions In men, especially over 50 years of age, ulceration o f the glans penis is highly suggestive of carcinoma. Precise different ial diagnosis is imperative. A lesion, such as the one reported, may c ause diagnostic difficulties when it presents in countries different f rom the source, where the condition is very uncommon. This is increasi ngly frequent in the current era of widespread air travel. (C) 1998 El sevier Science B.V.