A 61-years-old male, native from Minas Gerais State, Southeastern Brazil (deny travels overseas), retired electrician, with dyslipidemia and hypertension was admitted for evaluation of an ulcer on his tongue, which appeared five months after an ulcer on the dorsum of his right foot. Histopathology of the previous foot ulcer described a chronic inflammatory process with granuloma formation. Spiramycin and fluconazole were prescribed without improvement, therefore it was surgically removed.

Clinical examination showed a 3.5 by 2.5cm well-circumscribed ulcerated lesion on the left side of his tongue (Figure 1 A), submandibular and lymphadenopathies on the left side. Histopathology on incisional tongue biopsy showed pseudoepiteliomatous hyperplasia and dermal lymphohistiocytic infiltrate, rich in plasma cells, with no microorganisms. Routine laboratory investigations and ELISA test for leishmaniasis were negative or normal, including negative results for human immunodeficiency virus. Leishmanin skin test was positive and polymerase chain reaction performed on tongue biopsies revealed Leishmania subgenus Viannia (corresponding to Leishmania Viannia braziliensis due to local Leishmania species epidemiology). He was treated with liposomal amphotericin B - 3000mg cumulative dose (35mg/kg administered for 28-days), and presented complete tongue healing two months after treatment (Figure 1B), without any adverse effect. Physicians working in American Tegumentary Leishmaniasis endemic areas should be aware of this rare mucous form presented here whose clinical aspect may be differentiated mainly from epidermoid carcinoma.

Figure 1

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