We describe a case of isolated primary laryngeal leishmaniasis in an immunocompetent Italian patient with a previous medical history negative for visceral or cutaneous leishmaniasis, presenting with hoarseness. We also summarize the epidemiological, clinical, and diagnostic features and the therapeutic management of other cases of laryngeal leishmaniasis in immunocompetent subjects, described in the literature. Considering the insidious and nonspecific clinical presentation, the increasing number of different forms of mild or underestimated immunosuppressive conditions, and the number of people travelling in endemic zones, along with the ability of Leishmania amastigotes to survive for a long period in the body, we believe it is important for pathologists and clinicians to be aware of this unusual form of leishmaniasis in order to avoid delayed recognition and treatment. The rarity of the presentation and the lack of guidelines on mucosal leishmaniasis may contribute to the potential undiagnosed cases or delayed diagnosis, the possible relapses, as well as the correct pharmacological and/or surgical therapeutic approach. 1. Introduction Leishmaniasis is a zoonosis caused by protozoa of the genus Leishmania [1] and normally transmitted by the bite of the female Phlebotomus (and Lutzomiya) sandfly [2]. Extent and localization of lesions depend both on parasite characteristics and host immune response. Leishmaniasis can be clinically classified into three forms: cutaneous leishmaniasis (CL), visceral leishmaniasis (VL), and mucosal/mucocutaneous leishmaniasis (ML) [3]. In leishmaniasis, larynx is more often involved during ML, when mucosal lesions, firstly localized in the nose and/or oral cavity, may progressively descend the upper respiratory tract and sometimes involve the laryngeal mucosa. This is typical of Leishmania (L) braziliensis infection, which is common in South America [4]. However, some cases of primary laryngeal leishmaniasis, without previous or contemporary involvement of other sites, have been reported. These reports have been associated with L. donovani and L. infantum infection, which are typical of the Mediterranean Basin, India, and Sub-Saharan Africa [2]. Here, we present a case of primary isolated laryngeal leishmaniasis in an immunocompetent Italian patient and a review of the literature. 2. Case Presentation In July 2010, a 64-year-old Italian man presented to the Division of Infectious Diseases of the Garibaldi-Nesima Hospital of Catania with an 8-month history of hoarseness and discomfort. He lived in Sicily and he had not
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