Oyama Jully, Ferreira Fabiana Borges Padilha, Conter Carolina Cella, Lera-Nonose Daniele Stéfanie Sara Lopes, Ramos-Milaré Áquila Carolina Fernandes Herculano, Venazzi Eneide Aparecida Sabaini, Silveira Thaís Gomes Verzignassi, Lonardoni Maria Valdrinez Campana
Universidade Estadual de Maringá, Maringá, Paraná, Brazil.
Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, Paraná, Brazil.
Rev Inst Med Trop Sao Paulo. 2018;60:e3. doi: 10.1590/s1678-9946201860003. Epub 2018 Feb 15.
This clinical case presents a patient with a raised and ulcerative lesion with erythematous edges in the mouth, on the lower lip that was unsuccessfully treated as herpes labialis. Clinical data and laboratory tests (Montenegro skin test, indirect immunofluorescence, direct parasite search and polymerase chain reaction) led to the diagnosis of American tegumentary leishmaniasis caused by Leishmania (Viannia) sp. Treatment with pentavalent antimonial (Glucantime®) for 120 days was not effective and administration of amphotericin B for 30 days resulted in wound healing. Glucantime® treatment protocol was longer than the recommended by the Brazilian Ministry of Health in the handbook of mucosal leishmaniasis. This suggests that amphotericin B should have been administered earlier, preventing the psychological and social problems faced by the patient. This study reports a rare clinical case of primary mucosal leishmaniasis on the lip that had a delayed diagnosis, highlighting the precariousness in the management of disease and showing that, despite the importance of leishmaniasis in Brazil, it is still neglected by health professionals.
该临床病例介绍了一名患者，其下唇出现一个边缘呈红斑状的隆起溃疡性病变，最初按唇疱疹治疗未成功。临床资料和实验室检查（ Montenegro 皮肤试验、间接免疫荧光、直接寄生虫检测和聚合酶链反应）最终诊断为由利什曼原虫（维安尼亚利什曼原虫）引起的美洲皮肤利什曼病。使用五价锑剂（葡酸锑钠）治疗 120 天无效，而使用两性霉素 B 治疗 30 天则使伤口愈合。葡酸锑钠的治疗方案比巴西卫生部在黏膜利什曼病手册中推荐的时间更长。这表明应更早给予两性霉素 B 治疗，以避免患者面临的心理和社会问题。本研究报告了一例罕见的唇部原发性黏膜利什曼病临床病例，该病例诊断延迟，凸显了疾病管理的不稳定状况，并表明尽管利什曼病在巴西很重要，但仍被卫生专业人员忽视。
