Severe Nasal Destruction in Mucocutaneous Leishmaniasis: A Case Report

Abstract

Mucocutaneous leishmaniasis represents a severe complication of cutaneous leishmaniasis caused by Leishmania braziliensis, which may result in permanent facial deformity. We present the case of a 36-year-old cattle rancher from Santo Domingo de los Tsáchilas who developed a nasal lesion that progressed over 12 months to a destructive ulcerative lesion with perforation of the nasal septum and palatal involvement. The diagnosis was confirmed by direct smear demonstrating amastigote forms and PCR positive for Leishmania braziliensis. Despite treatment with meglumine antimoniate at 20 mg/kg/day for 28 days in accordance with the national treatment protocol, the lesion progressively worsened, ultimately requiring maxillofacial reconstructive surgery. The patient developed recurrence six months after the procedure, suggesting refractoriness to conventional therapy. This case illustrates the consequences of delayed diagnosis and highlights the need to strengthen access to sensitive diagnostic methods and second-line therapies within the Ecuadorian public health system in order to prevent irreversible sequelae associated with this neglected tropical disease.