Immunochromatography test for rK39 was persistently positive.
#Human muzzle skin
Skin biopsy revealed a granulomatous infiltration negative for acid-fast bacilli as well as leishmania donovan bodies. Enzyme-linked immunosorbent assay for human immunodeficiency virus infection was negative.
X-ray chest and ultrasound scan abdomen did not reveal any abnormality. Investigations revealed a normal hemogram and biochemical profile. The oral mucosa, tongue, and the rest of the skin, hair, and nails were not involved. A few skin colored papules were present over the anterior aspect of the neck and right ear lobule. The affected area was indurated and nontender.
Examination at presentation to this center revealed swelling of lips with diffuse swelling involving the “muzzle area” of the face (lips and perioral area extending onto the cheeks on both sides − the equivalent region of the primate muzzle area of the face). He, however, did give history of intermittent low-grade febrile illness, which would remit partially on antipyretics to relapse later, for the past 3 years. There was no history of any skin rash elsewhere, obvious trauma at the site of initial swelling, photosensitivity, weakness of a side of the face, swelling tongue, or oral mucosa, cough, loss of weight, anorexia, or alteration of bowel habits. Well-defined swelling of the muzzle area with swelling of the lips (pretreatment) and posttreatment (inset)