The clinical syndrome that results depends on a number of factors including the Leishmania species and immune response of the host. Here, we report successful treatment of lingual leishmaniasis complicating visceral disease in an immunocompetent patient. A 50-year-old National Guardsman with no significant medical problems presented with a 2-week history of a painful central tongue ulcer preceded by 2 weeks of tongue edema. He was deployed to Saudi Arabia during Operation Desert Storm in 1991 and to Iraq and Kuwait during Operation Iraqi Freedom (2002–2003). The lesion appeared 6 years after he returned from his last Rapamycin in vitro deployment. A 1.5-cm central cavitary lesion extending to the circumvallate

papillae with surrounding erythema, a smaller

0.5 cm lesion lateral to the midline, and oral candidiasis were noted on examination. Physical examination did not reveal any hepatosplenomegaly, lymphadenopathy, or abnormal skin findings. The platelet count was 115,000 µL but the white blood cell count and hemoglobin level were normal. Aspartate aminotransferase and alanine aminotransferase were 113 U/L and 132 U/L, respectively. The alkaline phosphatase level was 571 U/L, but the measurements of the total bilirubin, albumin, total protein, and renal function were normal. Incisional biopsy of the central tongue cavity done at presentation revealed squamous papilloma with candidiasis. The patient received nystatin suspension but no systemic antifungal therapy. During the subsequent 15 weeks, four additional lateral lesions developed and the central lesion enlarged. Laser excision biopsy of the central selleck screening library lesion was done to determine a definitive

etiology of the ulcers. Histopathologic evaluation showed marked non-caseating granulomas. The lesions continued to worsen, and 2 weeks later a partial glossectomy was done. Histopathologic examination revealed the presence of numerous intracellular amastigotes (Figure 1A and B). After the amastigotes were discovered, the previous biopsies were reexamined and were also noted to contain amastigotes. Review heptaminol of additional history revealed that the patient had experienced intermittent night sweats and an unintentional 40-pound weight loss over the last 5 years. While serving with the US military in Saudi Arabia in 1991, he had developed pruritic white and red macules on his arms, neck, and back. These lesions eventually waned and never became ulcerative. Punch biopsy of the back performed in 2004 revealed only a perivascular lymphocytic infiltrate. Since 2000, he had been noted to have thrombocytopenia. Liver function tests were noted to be abnormal in 2004 and liver biopsy demonstrated non-necrotizing granulomas, but no specific diagnosis was made. He recalled being bitten by various insects and had contact with various animals including dogs during both deployments. He lived in Tennessee and denied any additional travel history.