Superiority of local antimoniate over systemic liposomal amphotericin B therapy in a Leishmania infantum cutaneous leishmaniasis

Jean-Benjamin Murat,Olivier Epaulard,Danièle Maubon,Christophe Ravel,Isabelle Templier

doi:10.1099/jmmcr.0.000068

Abstract

Introduction: The therapeutic choice for treating cutaneous leishmaniasis (CL) can be difficult, notably in countries where autochthonous cases are rare. In France, CL is mostly due to imported cases. Leishmania infantum, which is the endemic species in the French south-eastern region, is usually responsible for visceral leishmaniasis but rarely causes the autochthonous cutaneous form of the disease. Intralesional injection of antimonials seems to be the most recommended therapy in the latter case, but particular situations can justify the use of systemic amphotericin B (AmB). Case presentation: We report and illustrate a French case of locally acquired CL due to L. infantum that was surprisingly unresponsive to systemic AmB, with clinical worsening and parasitic invasion of the lesion. Thereafter, the patient was successfully treated by intralesional pentavalent antimonial. Conclusion: This case supports the choice of intralesional therapy as the first therapeutic option in L. infantum CL, an infrequent situation in France.

Highlights

The therapeutic choice for treating cutaneous leishmaniasis (CL) can be difficult, notably in countries where autochthonous cases are rare
The therapeutic choice for treating cutaneous leishmaniasis (CL) remains complex, and recommendations depend on the geographical area of contamination, Leishmania species and lesion features (WHO, 2010)
Leishmania infantum, which is the endemic species in the French south-eastern region, is usually responsible for autochthonous visceral leishmaniasis; this species rarely causes the cutaneous form of the disease, it might be underdiagnosed and undernotified

Summary

Introduction

The therapeutic choice for treating cutaneous leishmaniasis (CL) remains complex, and recommendations depend on the geographical area of contamination, Leishmania species and lesion features (WHO, 2010). Leishmania infantum, which is the endemic species in the French south-eastern region, is usually responsible for autochthonous visceral leishmaniasis; this species rarely causes the cutaneous form of the disease, it might be underdiagnosed and undernotified. The patient had a recent history of pancreatic carcinoma, treated with complete pancreatectomy and chemotherapy 1 year before, but was considered cured and immunocompetent at the time of presentation. She did not report recent foreign travel but had been on a trip to southern France a few months before the onset of symptoms. Because of the obvious failure of systemic therapy, and despite the large size of the lesion, intralesional meglumine antimoniate injections were initiated. This led to a gradual regression of the lesion (Fig. 1c–f); the patient completely recovered in 3 months (Fig. 1g, h) with no side effects or sequelae

Conclusion

Discussion