Different species and geographic patterns:
(1) Latin America, due to L. braziliensis: termed espundia, it may develop years after the primary skin lesions have resolved
(2) Saudi Arabia, due to L. tropica: it may develop as part of the primary infection
(3) Sudan: it may develop in patients with visceral leishmaniasis
Lesions may involve:
(1) nasal mucosa, extending to nasal septum
(2) soft palate
(3) oral mucosa of the lips and cheeks
(4) nasopharynx and oropharynx
(5) larynx
Lesions may progress to ulceration and destruction, resulting in facial disfigurement. Blockage of the eustachian tubes can result in chronic middle ear infections.
Mucosal involvement may also be seen in immunocompromised patients with cutaneous leishmaniasis.
