{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,13]],"date-time":"2026-04-13T03:12:35Z","timestamp":1776049955966,"version":"3.50.1"},"reference-count":33,"publisher":"American Society of Tropical Medicine and Hygiene","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,8,2]]},"abstract":"<jats:p>Mucosal leishmaniasis (ML) is associated with progressive tissue destruction and granuloma formation, often after a considerable period of latency from an initial cutaneous infection. We report a case of recurrent epistaxis of 3 years duration and nasopharyngeal obstruction in a woman with treated cutaneous leishmaniasis nearly 30 years before and with no further exposure to Leishmania. Computed tomography revealed nasal septal perforation and histopathology demonstrated chronic inflammation. Microscopy was negative for amastigotes, but molecular testing of nasal mucosa biopsy detected <jats:italic>Leishmania (Viannia) braziliensis<\/jats:italic>. The patient underwent 28 days of treatment with IV sodium stibogluconate and her symptoms improved significantly. Sixteen months after treatment, she continues to have episodic epistaxis and detectable parasite load in her nasal lesion. Although ML is known to take years to decades to develop, there are few reported cases in the literature of such a long latency period. This report highlights the importance of considering ML in the differential diagnosis of chronic epistaxis in countries where leishmaniasis is endemic or in immigrants from these countries, even when presentation occurs decades after leaving an endemic region.<\/jats:p>","DOI":"10.4269\/ajtmh.17-0831","type":"journal-article","created":{"date-parts":[[2018,6,5]],"date-time":"2018-06-05T07:00:44Z","timestamp":1528182044000},"page":"327-330","source":"Crossref","is-referenced-by-count":8,"title":["Case Report: Mucosal Leishmaniasis Presenting with Nasal Septum Perforation after Almost Thirty Years"],"prefix":"10.4269","volume":"99","author":[{"given":"Jes\u00f9s","family":"Rojas-Jaimes","sequence":"first","affiliation":[{"name":"Department of Medicine, Universidad Cientifica del Sur, Lima, Peru;"},{"name":"Department of Sciences, Universidad Continental, Lima, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helena L.","family":"Frischtak","sequence":"additional","affiliation":[{"name":"University of Virginia School of Medicine, Charlottesville, Virginia;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose","family":"Arenas","sequence":"additional","affiliation":[{"name":"Hospital Nacional Guillermo Almenara Irigoyen ESSalud, Lima, Peru;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andres G.","family":"Lescano","sequence":"additional","affiliation":[{"name":"Emerge, Emerging Diseases and Climate Change Research Unit, School of Public Health and Administration, Universidad Cayetano Heredia, Lima, Peru"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2795","reference":[{"key":"b1","series-title":"Rev Peru Epidemiol","first-page":"1","article-title":"Leishmaniasis: una enfermedad desatendida. Un acercamiento a la realidad en Huepetuhe, Madre de Dios","volume":"16","author":"Rojas-Jaimes","year":"2012"},{"key":"b2","series-title":"An Bras Dermatol","first-page":"974","article-title":"American tegumentary leishmaniasis\u2014a case of therapeutic challenge","volume":"89","author":"Couto","year":"2014"},{"key":"b3","author":"Ministerio","year":"2015"},{"key":"b4","series-title":"J Infect Dev Ctries","first-page":"588","article-title":"Recent updates and perspectives on leishmaniasis","volume":"9","author":"Savoia","year":"2015"},{"key":"b5","series-title":"Int J Dermatol","first-page":"463","article-title":"Intralesional therapy of American cutaneous leishmaniasis with pentavalent antimony in Rio de Janeiro, Brazil\u2014an area of Leishmania (V.) braziliensis transmission","volume":"36","author":"Oliveira-Neto","year":"1997"},{"key":"b6","series-title":"PLoS One","first-page":"1","article-title":"Interventions for American cutaneous and mucocutaneous leishmaniasis: a systematic review update","volume":"8","author":"Reveiz","year":"2013"},{"key":"b7","series-title":"Clin Infect Dis","first-page":"677","article-title":"Efficacy of sodium stibogluconate alone and in combination with allopurinol for treatment of mucocutaneous leishmaniasis","volume":"25","author":"Llanos-Cuentas","year":"1997"},{"key":"b8","series-title":"Am J Trop Med Hyg","first-page":"556","article-title":"Polymerase chain reaction detection of leishmania kDNA from the urine of peruvian patients with cutaneous and mucocutaneous leishmaniasis","volume":"84","author":"Veland","year":"2011"},{"key":"b9","series-title":"Gac M\u00e9d Boliv","first-page":"91","article-title":"Leishmaniasis mucosa lar\u00edngea sin puerta de entrada evidente: presentaci\u00f3n de un caso cl\u00ednico","volume":"34","author":"Rojas-Cabrera","year":"2011"},{"key":"b10","series-title":"Bol Malariol Salud Ambient","first-page":"15","article-title":"Detecci\u00f3n de Leishmania braziliensis en lesi\u00f3n mucosa con 16 a\u00f1os de evoluci\u00f3n: registro de un caso","volume":"52","author":"A\u00f1ez","year":"2012"},{"key":"b11","series-title":"Am J Trop Med Hyg","first-page":"696","article-title":"Onset of espundia after many years of occult infection with Leishmania braziliensis","volume":"22","author":"Walton","year":"1973"},{"key":"b12","series-title":"Rev Med Panama","first-page":"6","article-title":"Mucocutaneous leishmaniasis in Panama: etiologic agent, epidemiologic and clinical aspects","volume":"14","author":"S\u00e1enz","year":"1989"},{"key":"b13","series-title":"Dermatol PERU","first-page":"37","article-title":"Leishmaniasis mucocut\u00e1nea con presentaci\u00f3n at\u00edpica: setenta a\u00f1os posprimoinfecci\u00f3n","volume":"23","author":"Saenz","year":"2013"},{"key":"b14","series-title":"Braz J Otorhinolaryngol","first-page":"843","article-title":"Mucosal leishmaniasis: epidemiological and clinical aspects","volume":"73","author":"Lessa","year":"2007"},{"key":"b15","series-title":"Clin Infect Dis","first-page":"e83","article-title":"Imported mucosal leishmaniasis in a traveler","volume":"37","author":"Scope","year":"2003"},{"key":"b16","series-title":"An Bras Dermatol","first-page":"642","article-title":"Final diagnosis of 86 cases included in differential diagnosis of American tegumentary leishmaniasis in a Brazilian sample: a retrospective cross-sectional study","volume":"92","author":"Tirelli","year":"2017"},{"key":"b17","series-title":"Postgrad Med J","first-page":"309","article-title":"Epistaxis: an update on current management","volume":"81","author":"Pope","year":"2005"},{"key":"b18","series-title":"Rev Med Exp","first-page":"1","article-title":"Diagnostico parasitologico de la leishmaniasis tegumentaria Americana","volume":"17","author":"Cuba","year":"2000"},{"key":"b19","series-title":"An Bras Dermatol","first-page":"701","article-title":"Complementary exams in the diagnosis of American tegumentary leishmaniasis","volume":"89","author":"Gomes","year":"2014"},{"key":"b20","series-title":"Int J Dermatol","first-page":"506","article-title":"American tegumentary leishmaniasis (ATL) in Rio de Janeiro State, Brazil: main clinical and epidemiologic characteristics","volume":"39","author":"De Oliveira-Neto","year":"2000"},{"key":"b21","series-title":"An Bras Dermatol","first-page":"892","article-title":"The use of polymerase chain reaction to confirm diagnosis in skin biopsies consistent with American tegumentary leishmaniasis at histopathology: a study of 90 cases","volume":"86","author":"Andrade","year":"2011"},{"key":"b22","series-title":"Lancet Infect Dis","first-page":"581","article-title":"Cutaneous leishmaniasis","volume":"7","author":"Reithinger","year":"2007"},{"key":"b23","series-title":"Int J Dermatol","first-page":"819","article-title":"Effect of combination therapy with systemic glucantime and pentoxifylline in the treatment of cutaneous leishmaniasis","volume":"45","author":"Sadeghian","year":"2006"},{"key":"b24","series-title":"Clin Microbiol Infect","first-page":"1471","article-title":"Leishmaniasis impact and treatment access","volume":"17","author":"Den Boer","year":"2011"},{"key":"b25","series-title":"Int J Dermatol","first-page":"179","article-title":"Treatment of mucocutaneous (American) leishmaniasis with amphotericin B: a report of 70 cases","volume":"10","author":"Sampaio","year":"1971"},{"key":"b26","series-title":"Lancet","first-page":"1191","article-title":"Leishmaniasis","volume":"354","author":"Herwaldt","year":"1999"},{"key":"b27","series-title":"Clin Microbiol Infect","first-page":"1478","article-title":"Leishmaniasis chemotherapy-challenges and opportunities","volume":"17","author":"Croft","year":"2011"},{"key":"b28","series-title":"Lancet Glob Health","first-page":"e51","article-title":"Efficacy and safety of single-dose liposomal amphotericin B for visceral leishmaniasis in a rural public hospital in Bangladesh: a feasibility study","volume":"2","author":"Mondal","year":"2014"},{"key":"b29","series-title":"Clin Infect Dis","first-page":"1266","article-title":"Miltefosine for new world cutaneous leishmaniasis","volume":"38","author":"Soto","year":"2004"},{"key":"b30","series-title":"Clin Infect Dis","first-page":"1104","article-title":"Oral pentoxifylline and pentavalent antimony for treatment of leishmaniasis: promising but Inconclusive evidence of superiority, compared with antimony monotherapy","volume":"45","author":"Ojha","year":"2007"},{"key":"b31","series-title":"Clin Infect Dis","first-page":"788","article-title":"Oral pentoxifylline combined with pentavalent antimony: a randomized trial for mucosal leishmaniasis","volume":"44","author":"Machado","year":"2007"},{"key":"b32","series-title":"Am J Trop Med Hyg","first-page":"617","article-title":"Clinical and immunological outcome in cutaneous leishmaniasis patients treated with pentoxifylline","volume":"90","author":"Brito","year":"2014"},{"key":"b33","series-title":"Am J Trop Med Hyg","first-page":"87","article-title":"Successful treatment of refractory mucosal leishmaniasis with pentoxifylline plus antimony","volume":"65","author":"Lessa","year":"2001"}],"container-title":["The American Journal of Tropical Medicine and Hygiene"],"original-title":[],"link":[{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/99\/2\/article-p327.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/99\/2\/article-p327.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/www.ajtmh.org\/downloadpdf\/journals\/tpmd\/99\/2\/article-p327.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,31]],"date-time":"2024-07-31T19:31:00Z","timestamp":1722454260000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajtmh.org\/view\/journals\/tpmd\/99\/2\/article-p327.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,8,2]]},"references-count":33,"journal-issue":{"issue":"2"},"URL":"https:\/\/doi.org\/10.4269\/ajtmh.17-0831","relation":{},"ISSN":["0002-9637","1476-1645"],"issn-type":[{"value":"0002-9637","type":"print"},{"value":"1476-1645","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,8,2]]}}}