A 35-year-old man returning from the Amazon presents with a destructive lesion involving the nasal septum and oral mucosa, with a 'tapir nose' deformity. Skin smear shows kinetoplast-bearing amastigotes. The causative agent and the treatment of choice are:

• A L. tropica; sodium stibogluconate
• B L. braziliensis; liposomal amphotericin B or miltefosine ✓
• C L. mexicana; fluconazole
• D L. major; meglumine antimoniate

Explanation

Mucocutaneous leishmaniasis (espundia) is caused by Leishmania braziliensis (and related Viannia subgenus species) in Latin America. It causes destructive naso-oral mucosal lesions ('tapir nose' deformity from nasal and upper lip involvement) that can appear years after healing of the primary cutaneous lesion. Treatment requires systemic therapy — liposomal amphotericin B (first-line for mucosal disease) or miltefosine. Pentavalent antimonials (sodium stibogluconate, meglumine antimoniate) are alternatives. L. tropica is Old World cutaneous leishmaniasis.

Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.