Gingival leishmaniasis is unusual and is mainly observed in immunocompromised patients. We report a case involving the palate, uvula, and gingiva of an HIV-negative patient who was initially diagnosed as having paracoccidioidomycosis. The patient underwent a biopsy for parasite isolation and in situ histopathology and immunohistochemistry. The Leishmania spp. were detected in lesions of the uvula and gingiva. Despite the poor state of teeth, the gingival lesions were caused by American tegumentary leishmaniasis (ATL). The gingival lesions presented an intense inflammatory infiltrate permeated by neutrophils. Immunohistochemistry revealed a predominantly lymphocytic infiltrate. The patient responded well to treatment, with no reactivation during follow-up. The rarity of gingival involvement in immunocompetent patients and the need for inclusion of ATL in the differential diagnosis of gingival lesions are discussed.