Clinical spectrum of nasal leishmaniasis in Muzaffarabad.

OBJECTIVE: To determine the frequency of nasal leishmaniasis and the presentation of disease involving nose as well as nasal mucosa in patients reporting from the Muzaffarabad district of Azad Jammu and Kashmir (AJK).

STUDY DESIGN: Case series.

PLACE AND DURATION OF STUDY: Combined Military Hospital, Muzaffarabad, from January 2006 to May 2008.

METHODOLOGY: All patients belonging to Muzaffarabad district of AJK, clinically suggestive of Cutaneous Leishmaniasis (CL) and supported by laboratory diagnosis were registered. Diagnosis was made on the basis of clinical characteristics of the lesions, laboratory demonstration of leishmania trophozoite bodies on skin smears or skin biopsies and therapeutic trials. Those having lesions primarily on nose, irrespective of age and gender were included in the study. All those cases with primary lesion elsewhere over face and secondarily involving nose (by extension of primary lesion) were excluded. Various demographical features of the patients and clinical patterns of the lesions were recorded in all cases and subsequently categorized accordingly.

RESULTS: Seventy three out of 252 (29%) cases of nasal leishmaniasis were encountered. Male to female ratio was 43:30. Fifty five had solitary lesions which were restricted only to nose in 51 patients. Morphological patterns included psoriasiform (30), furunculoid (8), nodular (13), lupoid (8), mucocutaneous (4), rhinophymous (3), erysipeloid (1), basal cell carcinoma-like (1), discoid lupus erythematosis-like (1), mutilating (2), verruciform (1) and keloidal (1).

CONCLUSION: Nose was a common site of involvement in CL, where the disease can present in various forms. In endemic areas, CL should be included in the differential diagnosis of all nasal lesions.