Abstract Introduction Leishmaniasis is a zoonotic disease caused by protozoa of the genus Leishmania, transmitted by the bite of infected sandflies. The most common clinical presentations are cutaneous and mucocutaneous. Mucocutaneous leishmaniasis (L. braziliensis, L. panamensis, and L. guyanensis) may affect the nasal, oropharyngeal, and laryngeal mucosa, leading to progressive tissue destruction. Tracheal and bronchial involvement is extremely rare and usually reflects delayed diagnosis. We present the case of a patient with diffuse tracheal stenosis secondary to Leishmania infection, an unusual manifestation that broadens the clinical spectrum of this parasitic disease. Case Report A 54-year-old male farmer from Cusco, living in Pucallpa, presented with a seven-year history of dysphonia, exertional dyspnea (mMRC 2), progressive stridor, and dysphagia. Laryngoscopy revealed a 70% nasopharyngeal lumen reduction, severe laryngeal edema with ventricular band deformation, suggesting granulomatous disease. GeneXpert MTB/RIF and sputum smears were negative for M. tuberculosis. Initial laryngeal biopsies were nondiagnostic. The patient was hospitalized and started on low-dose corticosteroids. CBC and vasculitis work-up were unremarkable. Leishmanin skin test was positive. Chest CT showed diffuse tracheal stenosis without parenchymal disease. Fiberoptic bronchoscopy confirmed tracheal stenosis (6 mm) with mucosal edema and retraction. Biopsy was performed and results showedchronic non-specific inflammation, bronchial aspirate was negative for fungus and TB. Repeat laryngeal biopsy of granulomatous lesion demonstrated intracellular amastigotes, diagnostic of leishmaniasis. Liposomal amphotericin B was initiated. After three weeks, repeat bronchoscopy showed reduced laryngeal granulomatous lesions, tracheal adhesions limited to the proximal third and lumen widening to 9 mm. The patient reported symptomatic improvement. Discussion In leishmaniasis, respiratory involvement is rare and tracheal stenosis is exceptional. This case highlights the importance to consider this etiology in endemic-area patients with unexplained airway obstruction not attributable to more common causes. The pathogenesis of tracheal stenosis secondary to Leishmania likely involves chronic granulomatous inflammation which leads to progressive destruction of the respiratory epithelium with subsequent fibrotic scarring. Early recognition is essential to prevent severe respiratory complications. This case underscores the importance of thorough histopathological evaluation and a broad diagnostic approach in atypical presentations of airway obstruction. In the future, we expect to cure the infection a then manage the tracheal stenosis with cryobiopsy and bronchial dilation. This abstract is funded by: None
Jimenez et al. (Fri,) studied this question.