Leishmania Recidivans Could Be Induced by Intralesional Infiltration of Cutaneous Leishmaniasis by Sodium Stibogluconate, with New Therapeutic Trial

Abstract

Objective: Leishmania recidivans is a chronic form of cutaneous leishmaniasis with characteristic picture. So the aim of this study is to record all cases of leishmania recidivans that had history of therapy of cutaneous leishmaniasis by sodium stibogluconate. Patients and methods: This is case series descriptive study and interventional therapeutic. Twenty-two patients with clinical picture of leishmania recidivans were included. All gave a history of cutaneous leishmaniasis of 2-4-month duration before the time of therapeutic injection with sodium stibogluconate. They were treated by intralesional injections of sodium stibogluconate for several times and every two weeks and months to years before the present presentation and examination. Patients were treated by combination of oral ketoconazole, oral zinc sulfate and topical 15-25% podophyllin for around 1-2 months. Results: Twenty-two patients were evaluated, their ages ranged from 1-20 years with a median of 10 years, with 16 (72.72%) males and 6 (27.27%) females. The location of lesions was mostly on the face and upper limbs. On examination, there were ill-defined plaques with clearing at the centers leaving some atrophy and scarring at the centers of lesions while there were active dusky red papules and nodules at periphery of primary lesion. The response to therapeutic regime was obvious after three weeks and was marked after one month and almost complete clearance at 2 months. Conclusions: This work showed a new explanation for leishmania recidivans evolution as intralesional therapy of cutaneous leishmaniasis had induced leishmania recidivans. Oral ketoconazole and zinc sulfate combined with topical podophyllin are effective modes of treatment for leishmania recidivans.