Genital Tegumentary Leishmaniasis With Syphilis-Like Lesion – Case Report

Leishmaniases are anthropozoonoses with significant clinical repercussions and are considered a public-health problem in Brazil. Within this group, American cutaneous leishmaniasis (ACL) stands out as an infectious disease caused by protozoa of the Leishmania complex, transmitted by the bite of female phlebotomine sandflies. Clinically, ACL is divided into localized cutaneous leishmaniasis, disseminated cutaneous leishmaniasis, diffuse cutaneous leishmaniasis, and mucosal leishmaniasis. Genital lesions are uncommon presentations of ACL and may result from hematogenous dissemination or direct inoculation of the parasite. Syphilis stands out as one of the important differential diagnoses of genital ulcerative lesions; therefore, laboratory confirmation—such as lesion scraping to test for Leishmania – is crucial for diagnosis, and case reports of this nature alert health teams to genital involvement in ACL. The objective of this work is to present a case of ACL in Northern Brazil (an endemic region) in the second half of 2020, with a cutaneous lesion in the genital region, enabling discussion of clinical and epidemiological aspects, emphasizing differential diagnoses and particularities of pharmacologic treatment. Male, 52 years old, of mixed residence (alternating between rural and urban areas), presented to a primary health unit in the second half of 2020 with a complaint of a single, painless penile lesion for 40 days that had increased in size. He had self-medicated with neomycin and rifocin for five days, without improvement. He reported prior leishmaniasis in 2006 requiring hospitalization for correct treatment. He denied known comorbidities, chronic medication use, or allergies. He also denied smoking and alcohol use. He reported heterosexual relations with a single partner and no condom use. Physical examination showed a single, ulcerated lesion with a clean base, approximately 1.5 cm, on the prepuce in the superior region of the penis (see Figure 1), with no lymphadenopathy.