Abstract
In Brazil, meglumine antimoniate is the first drug of choice for mucosal leishmaniasis treatment followed by amphotericin B and pentamidine isethionate. We report the case of a patient with severe mucosal lesions caused by Leishmania (Viannia) braziliensis that were difficult to treat. Over a 14-year period, the patient showed low adherence and three treatment attempts with meglumine antimoniate failed. Additionally, there was an unsatisfactory response to liposomal amphotericin B and nephrotoxicity when using amphotericin B deoxycholate that persisted after new treatment attempt with liposomal amphotericin B. Finally, healing was achieved with pentamidine isethionate and maintained during nine months of monitoring.
Highlights
American tegumentary leishmaniasis (ATL) can affect the skin and/or mucosa of the upper aerodigestive tract
In this study we described a case of mucosal leishmaniasis (ML) caused by L. (V.) braziliensis acquired in Rio de Janeiro with low adherence and poor response to meglumine antimoniate (MA), failure and intolerance to amphotericin B, and lesion healing after using pentamidine isethionate
L. (V.) braziliensis promastigote forms from Rio de Janeiro were more sensitive, in vitro than strains of other origins, which could explain the good response of ATL to low doses of MA in Rio de Janeiro[8]
Summary
American tegumentary leishmaniasis (ATL) can affect the skin and/or mucosa of the upper aerodigestive tract. A 50-year-old male patient, born in Rio de Janeiro, was examined in March 1998 at the Evandro Chagas National Institute of Infectious Diseases (INI) with complaints of rhinorrhea, nasal obstruction and dysphonia for 10 months, without active skin lesions or scars suggestive of cutaneous leishmaniasis. (V.) braziliensis acquired in Rio de Janeiro with low adherence and poor response to MA, failure and intolerance to amphotericin B, and lesion healing after using pentamidine isethionate.
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