Differentiation between leishmaniasis and histoplasmosis remains a significant diagnostic conundrum, especially in immunosuppressed patients, due to overlapping clinical presentations and histopathological features. We report a case of a 53-year-old Thai man with advanced HIV disease from Southern Thailand who presented in 2020 with a chronic palate ulcer and hard palate perforation, initially diagnosed as histoplasmosis and treated with itraconazole for a year. Three years later (2023), the patient developed systemic symptoms, and biopsies confirmed visceral leishmaniasis. Given the increasing number of autochthonous leishmaniasis cases, the patient's original diagnosis from 2020 was reexamined. Retrospective analysis of the original palate biopsy revealed amastigotes with kinetoplasts, whereas PAS and GMS staining were negative for fungi, excluding histoplasmosis. Molecular diagnostics, which combined PCR for Leishmania spp. and Histoplasma capsulatum with Sanger sequencing, confirmed Leishmania martiniquensis and ruled out Histoplasma capsulatum, leading to a corrected diagnosis of mucocutaneous leishmaniasis. This report documents the second case of mucocutaneous leishmaniasis caused by L. martiniquensis in Thailand, with primary mucocutaneous presentation that progressed to visceral involvement. This highlights diagnostic challenges due to morphological similarities between Leishmania amastigotes and Histoplasma capsulatum yeasts, emphasizing the need for integrative histopathological (including specific staining techniques) and molecular diagnostics for accurate diagnosis and effective treatment.

Introduction: Introduction: Melasma is a chronic, relapsing dermatological disorder for which effective treatment remains limited. Intradermal tranexamic acid (TXA) and platelet‐rich plasma (PRP) have recently gained attention as potential therapeutic options. However, their comparative efficacy and safety have not been systematically assessed. Methods: Methods: This systematic review and meta‐analysis was conducted in accordance with the PRISMA statement guidelines and registered in PROSPERO (CRD42024614462). Electronic databases including the Cochrane Library, PubMed, ScienceDirect, Scopus, Google Scholar, and Thai Index Medicus were searched for comparative clinical studies evaluating intradermal TXA versus PRP in patients with melasma. Data were analyzed using the Cochrane Review Manager. The primary outcome was the change in Melasma Area and Severity Index (MASI) or modified MASI (mMASI) scores. Results: Results: Five studies comprising a total of 207 adult participants met the inclusion criteria and were included in the meta‐analysis. Both intradermal TXA and PRP were associated with clinical improvement in MASI/mMASI scores. Pooled meta‐analysis demonstrated no statistically significant difference between the two treatment modalities. Reported adverse effects were generally mild and transient, including erythema, injection‐site congestion, postinflammatory hyperpigmentation, and temporary discoloration. Conclusion: Conclusion: Current comparative evidence suggests that both intradermal TXA and PRP are effective and generally well tolerated for melasma treatment, without demonstrable superiority of either modality. Interpretation is limited by small sample sizes, methodological heterogeneity, and moderate risk of bias. Future large‐scale randomized controlled trials with standardized outcome measures and longer follow‐up durations are warranted to clarify the comparative efficacy and durability of these treatments.

A 23-year-old man reported a 3-year history of slowly growing, slightly itchy, flesh-colored papules on the distal glans penis. He denied any history of trauma or previous treatment. Additionally, he experienced no difficulties with urination, discharge, or erectile function. Upon examination, three firm, dome-shaped papules were found to be attached to the skin but mobile over the underlying tissues. There was no regional lymph node enlargement, hardening, or fluctuation observed. Histopathological analysis revealed a well-defined, encapsulated tumor in the dermis, consisting of spindle cells interspersed with varying numbers of axons.