Laryngeal granulomatous disease: when thinking of leishmaniasis OBJECTIVE: To report a case of laryngeal granulomatous disease with an atypical course, including diagnosis and therapy. CASE REPORT: A 65-year-old male patient had progressive dysphonia for a year; with telelaryngoscopy, we saw a granulomatous lesion that partially destroyed the epiglottis and occupied the vestibule and glottis, with preserved vocal fold mobility. Six years before this presentation, the patient underwent radiotherapy and chemotherapy for carcinoma in situ of the soft palate, from which he fully recovered. The patient recently appeared with a granulomatous lesion in the entrance of the right nasal cavity. The results of the laryngeal biopsy showed chronic non-caseating granulomatous laryngitis. He was initially administered a specific treatment for tuberculosis. No symptom improvement or lesion appearance was observed, and he started having dysphagia, nocturnal fever, weight loss, difficulty breathing, and purulent exudate upon injury. A new approach was commenced and included tracheostomy, laryngeal biopsies, and treatment with cefepime and amphotericin B. A new histopathological examination showed a chronic nonspecific inflammatory process. The patient had symptom improvement and the appearance of lesions with endoscopy. CONCLUSION: Laryngeal leishmaniasis should be considered as a differential diagnosis of granulomatous diseases, especially in cases with an associated nasal injury. The specific diagnosis is difficult because of the scarcity of parasites in this clinical form, leading to delays in diagnosis and treatment of these patients.