Intralesional treatment with meglumine antimoniate in three patients with New World cutaneous leishmaniasis and large periarticular lesions with comorbidities.

Maria Inês Fernandes Pimentel,Carla De Oliveira Ribeiro,Mauricio Naoto Saheki,Armando De Oliveira Schubach,Marcelo Rosandiski Lyra,Érica De Camargo Ferreira E Vasconcellos,Mariza De Matos Salgueiro,Liliane De Fátima Antonio

doi:10.1590/0037-8682-0323-2016

Abstract

Although New World cutaneous leishmaniasis is not itself a life-threatening disease, its treatment with systemic antimonials can cause toxicity that can be dangerous to some patients. Intralesional meglumine antimoniate provides a viable, less toxic alternative. Herein, we describe an alternative treatment with subcutaneous intralesional injections of meglumine antimoniate into large periarticular lesions of three patients with cutaneous leishmaniasis and comorbidities. This treatment was safe, successful, and well tolerated. This case series suggests that intralesional meglumine antimoniate is an effective therapy for cutaneous leishmaniasis, even with periarticular lesions. This hypothesis should be tested in controlled clinical trials.

Highlights

The first-choice treatment for American tegumentary leishmaniasis (ATL) is systemic pentavalent antimonials
We describe an alternative treatment with subcutaneous intralesional injections of meglumine antimoniate into large periarticular lesions of three patients with cutaneous leishmaniasis and comorbidities
The World Health Organization recommended that decisions regarding treatment must be based mainly on the risk–benefit ratio of the intervention for each patient, and that local and less toxic treatments should be explored since mucocutaneous leishmaniasis occurs in less than 5% of cases, and systemic treatment does not prevent its occurrence[1]

Summary

INTRODUCTION

The first-choice treatment for American tegumentary leishmaniasis (ATL) is systemic pentavalent antimonials. The National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation (Fiocruz), is a referral center for the treatment of ATL in Rio de Janeiro, Brazil. At this institution, intralesional (IL) treatment with meglumine antimoniate (MA) has been performed for over 30 years in selected patients with cutaneous leishmaniasis without mucosal lesions[2], especially in those with contraindications to the systemic use of MA3. The Pan-American Health Organization (PAHO) recommends that IL therapy should be administered via the intradermal route in referral centers for single lesions up to 900 mm[2] in any location except the head and periarticular sites when immunosuppression is absent and patient follow-up is possible[5].

DISCUSSION

Findings

Method of parasitological confirmation