Image 31: A  45 year old male from Peru, in Canada for 16 years, developed a sore throat and a stuffy nose over the two years before we saw him this year. In the two years his nose became blocked, he had intermittent epistaxis and his swallowing became more difficult and uncomfortable. When seen here his posterior pharynx was as shown here. He was afebrile and had normal hematologic and hepatic indices. What is the diagnosis and diagnostic test?

raspberry-like uvula, soft palate and posterior pharynx

31

Image 31: This is mucocutaneous leishmaniasis.  A pharynx scraping grew Leishmania and both the scraping  and the culture were positive for Leishmania braziliensis by PCR (National Centre for Parasitology, Canada). A biopsy a year earlier at another centre revealed "caseating" granulomata but no amastigotes. The patient remembered being treated 18 years earlier in Peru with intra-lesional injections for a shoulder and a leg ulcer and still had scars at these sites.