10 
Case 8.—A 64-year-old Negro woman from Jamaica, B. W. I. This case has been published 
previously, 15 when the antigen for the Montenegro test was not yet available. Since the observa¬ 
tion of the patient was resumed later, when the test could be carried out, further description 
appears to be warranted. 
History. —Obstruction of the right nostril for two years. Protruding growth which bleed on 
touch present for one month. 
General Physical Examination.—A few spot-like depigmented areas noted on the anterior 
aspect of both legs. A white scar on the anterior aspect of the left leg. Kahn test doubtful. Other¬ 
wise general examination, including roentgenogram of the chest, entirely normal. Thick smear for 
malaria negative. Urine normal. 
0tolaryngological Examination. —The skin of the tip and the anterior third of the external 
nose was reddened, thickened, and slightly wrinkled. The skin of the inner aspects of the alae 
showed a similar appearance. From the right nostril a tumor of about walnut size, with a 
reddish, slightly irregular surface, was protruding (Fig. 3). On touch the growth bled slightly. 
Anterior rhinoscopy of the right nasal cavity was impossible. Anterior rhinoscopy of the left 
nasal cavity showed a bleeding ulcer of the anterior part of the septum. Posterior rhinoscopy 
and laryngoscopy not remarkable. Roentgenograms of the sinuses normal. Examination of the ears 
revealed an extensive defect in the helix of the left auricle, without any fresh lesion (Fig. 1). 
Otherwise no abnormal findings. 
Operation. —The tumor was easily removed with a cold snare. There was not much bleeding. 
The insertion of the pedunculated growth was found to be on the upper anterior part of the 
cartilaginous septum, near the vestibulum. No other lesions were seen in the right nasal cavity. 
Smears from fresh tumor tissue for Leishmania and Mycobacterium leprae were negative. 
Histological Examination. —Histological examination of tumor material fixed in formalin 
(Prof. Rudolf Jaffe, Caracas) revealed the following: Granulation tissue with many dilated 
vessels, partly infiltrated by large numbers of plasma cells, partly by many polymorphonuclear 
leucocytes, so that microscopic abscesses were formed. There was a moderately large number 
of giant cells, mostly like foreign-body cells, and a foreign body, the nature of which could not 
be determined. In other parts there were noduli with giant cells, as in tuberculosis. The histo¬ 
logical findings did not allow a definite diagnosis. 
During the following six months 72 cc. of stibophen was given, as well as 21 tablets (0.1 gm.) 
of quinacrine (Mepacrine; Atabrine hydrochloride). After two months the ulceration in the left 
nasal cavity healed completely, without any local procedure, and the skin of the external nose 
and the vestibulum had improved very much. After six months the nose was entirely normal. 
Since the Kahn test had been “doubtful” at the beginning of the observation, the V.D.R.L. 
test was done toward the end of the treatment period and results were negative. No antisyphilitic 
treatment had been administered. 
About one year after the discharge of the patient, and after publication of the first report, she 
returned with a recurrence of the dermatosis in the tip of the nose. Rhinoscopical examination 
was normal. Montenegro test was strongly positive, with a large inflammatory zone and forma¬ 
tion of blisters. The skin lesion of the nose healed under stibophen therapy only. 
Comment .—Antigen for the Montenegro test became available only after the 
patient had been discharged and the case had been published as a “probable polypous 
form of leishmaniasis of the nose/’ The strongly positive reaction of the intradermal 
test during the second observation and the healing once more of the cutaneous lesion 
after antimony treatment clinch the diagnosis. 
Mangabeira-Albernaz 16 was the first to publish, in 1925, observations on the 
polypous form of leishmaniasis. Reading his reports in the original, one encounters 
a striking similarity between some of his cases and the one reported above. 
The dermatosis of the tip and the anterior part of the nose looked like beginning 
rhinophyma. Rhinophyma in American leishmaniasis had been observed by Vein- 
temillas and Castillo, 17 and rhinophyma-like lesions in Oriental sore, by Quiruga, 
Curia, and Ursi. 18 
11 
SUMMARY 
American leishmaniasis occurs from Mexico to the Argentine. Lesions of the 
mucosa, especially of the nose, are more frequent in the southern countries of the 
New World than further north. They may lead to extensive destruction of the upper 
respiratory tract, and even endanger life. Occasionally the condition has been found 
also in the temperate zone in persons who have resided in endemic regions. Only 
one case of affection of the nasal mucosa has been reported in the past from Panama. 
To this the present communication adds eight further observations, one of which had 
been previously reported in part. The intradermal reaction of Montenegro has been 
found very helpful in making the diagnosis. 
I am indebted to Dr. G. A. Engler for the photographs for Figures 3 and 4 and to Dr. B. M. 
Cino for the photograph for Figure 2. 
REFERENCES 
1. Fasal, P., and Gradow, A.: Intradermal Leishmanin Test (Montenegro Test) in Diagno¬ 
sis of Cutaneous Leishmaniasis: Report of a Case of Chiclero Ulcer Diagnosed in California, 
A. M. A. Arch. Dermat. & Syph. 64:487, 1951. 
2. Reipen, W.: Leishmania-Erkrankung der Nase, Ztschr. Laryng. Rhin. Otol. 30:177, 1951. 
3. Partenheimer, K.: Ein Beitrag zur Kenntnis der sudamerikanischen Schleimhautleish- 
maniose (Espundia), Arch. Ohren- Nasen- u. Kehlkopfh. 155:116, 1947. 
4. Bates, L. B.: Leishmaniasis (Oriental Sore) of the Nasal Mucosa, Proc. Canal Zone M. 
A. 5:83, 1913. 
5. Strong, R. P.: Stitt’s Diagnosis, Prevention and Treatment of Tropical Diseases, Ed. 7, 
Philadelphia, Blakiston Company, 1944. 
6. Pessoa, S. B., in Clinical Tropical Medicine, edited by R. B. H. Gradwohl, L. B. Soto, and 
O. Felsenfeld, St. Louis, C. V. Mosby Company, 1951. 
7. Villela, F.: Statistical Data on Mucosal Leishmaniasis in Araqatuba, S. Paulo, Trop. Dis. 
Bull. 37:352, 1940. 
8. Klotz, O., and Lindenberg, H.: The Pathology of Leishmaniosis of the Nose, Am. J. 
Trop. Med. 3:117, 1923. 
9. Pessoa, S. B., and Barretto, M. P.: Distribution of Parasites and Intensity of Parasitism 
in South American Cutaneous Leishmaniasis, Trop. Dis. Bull. 43:1127, 1946. 
10. Jaffe, R.: Histopathological Picture of American Leishmaniasis, Pract. oto-rhino-laryng. 
6:45, 1944. 
11. Pupo, J. A.: Estudo clinico da leishmaniose tegumentar Americana, Rev. Hosp. din. 
1:113, 1946. 
12. Montenegro, J.: Cutaneous Reaction in Leishmaniasis, Arch. Dermat. & Syph. 13:187, 
1926. 
13. Wagener, E. H.: A Skin Reaction to Extracts of Leishmania Tropica and Leishmania 
Infantum, Univ. California Publ. Zool. 20:477, 1923. 
14. Annual Report of the Gorgas Memorial Laboratory, 1952, Washington, D. C., United 
States Government Printing Office, 1953. 
15. Jaffe, L.: Probable Polypous Form of Leishmaniasis of the Nose, Pract. oto-rhino-laryng. 
14:14, 1952. 
16. Mangabeira-Albernaz, P.: Estudo critico do “polipo da leishmaniose,” Brasil-med. 61:283, 
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6:10, 1946. 
18. Quiruga, M. I.; Curia, L., and Ursi, C. G.: Leishmaniasis simulando un rinofima, Rev. 
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Printed and Published in the United States of America 
