Clinical features:
(1) one or more tongue ulcers
(2) pain in the tongue
(3) tongue edema
(4) may be associated with systemic symptoms (fever, night sweats, weight loss)
Risk factors:
(1) HIV infection
(2) organ transplant
(3) immunocompromise associated with malignancy
(4) corticosteroid use or therapy with other immunosuppressive drugs
(5) other immunosuppressive conditions
Biopsy shows:
(1) noncaseating granulomas
(2) intracellular amastigotes
(3) positive PCR
Challenges in diagnosis:
(1) prolonged period between exposure and onset
(2) absence of a history of leishmaniasis
(3) presence of an alternative diagnosis
(4) evaluation in a region where leishmaniasis is rare
