American cutaneous Leishmaniasis (ACL) is caused by protozoa of the genus Leishmania, and affects the skin and the oral, nasal, pharyngeal and laryngeal mucous membranes. Mucosal lesions (ML) occur in patients with immunodeficiency or with relatively poor dental conservation, and may have secondary colonization by other infectious agents. In this case, the clinical and histopathological lesions underwent changes, making diagnosis difficult. A 69-year-old man and ex-smoker presented with an oral lesion for 3 years associated with odynophagia, dysphagia, and weight loss. Amputation of the uvula and palate lesions were present in a hard, soft, and grainy pharynx, permeated by shallow, ulcerated areas with a yellowish background, suggesting a superimposed secondary infection. Hyperplasia was also observed per camera suction caused by upper dentures and hyposalivation. The Montenegro test showed a strong ballast of 40 mm, and the histopathological results were nonspecific. ML were confirmed by PCR for Leishmania sp. in injured tissue. The isolation for Leishmania was negative, but there was growth of Candida spp. in cultivations from injuries. Treatment was with meglumine antimoniate 5 mg/kg/day and pentoxifylline 400 mg (total of 30 doses) with LTA and Daktarin topical gel for candidiasis; in the end, there was both scarring of the injury and healing. ACL lesions modified by the presence of prosthesis or associated with other infections are a challenge for the correct diagnosis of ACL, requiring additional tests not used in routine outpatient settings. The presence of Candida spp. hindered the culture of Leishmania, which could only be detected using a PCR method that is not available at all centers.
