Laryngeal Leishmaniasis presenting with hoarseness in a child from the highland of Nepal: a rare diagnostic challenge

Leishmaniasis, predominantly a disease endemic to rural lowlands in Nepal, is transmitted by sand flies and is extremely unusual at highland elevations. Respiratory mucosal involvement in leishmaniasis is rare, causing a diagnostic dilemma. We report a 6-year-old child from a hilly region of Nepal (2500 m above mean sea level), presenting with hoarseness of voice for a two-month duration, and ultimately diagnosed as isolated laryngeal leishmaniasis. This presentation highlights the diagnostic challenge in the context of evolving disease ecology, posed by the diverse clinical spectrum of leishmaniasis in the pediatric population and the importance of this differential in any unexplained granulomatous inflammation. • Leishmaniasis can present as an isolated laryngeal symptom in children. • The diverse clinical spectrum of leishmaniasis highlights the diagnostic challenge. • Although causal inference cannot be drawn from a single case, this case may represent shifting leishmaniasis epidemiology associated with climate change.