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Am. J. Trop. Med. Hyg., 75(6), 2006, pp. 1074-1077
Copyright © 2006 by The American Society of Tropical Medicine and Hygiene

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RELAPSE OF NEW WORLD DIFFUSE CUTANEOUS LEISHMANIASIS CAUSED BY LEISHMANIA (LEISHMANIA) MEXICANA AFTER MILTEFOSINE TREATMENT

MANUEL CALVOPINA*, EDUARDO A. GOMEZ, HERBERT SINDERMANN, PHILIP J. COOPER, AND YOSHIHISA HASHIGUCHI
Department of Parasitology, Kochi Medical School, Kochi University, Kochi, Japan; Departamento de Epidemiologia, Instituto Nacional de Higiene y Medicina Tropical Leopoldo Izquieta Perez, Guayaquil, Ecuador; Medical Research and Development, Zentaris, Frankfurt, Germany; Laboratorio de Investigaciones, Hospital Pedro Vicente Maldonado, Pichincha Province, Ecuador

A 35-year-old man with a 19-year history of slowly evolving diffuse cutaneous leishmaniasis was treated with oral miltefosine, 50 mg three times a day. The patient responded after four months of miltefosine treatment with clearance of all nodular lesions and plaques from the entire body surface and had negative slit-skin smears and cultures for Leishmania. However, two months after stopping miltefosine, skin lesions reappeared and parasites were observed in samples. The relapsed lesions did not respond to an additional two-month course of miltefosine. No laboratory or clinical adverse events to miltefosine were observed. Parasites from skin lesions were cultured and identified as Leishmania (Leishmania) mexicana by isoenzyme electrophoresis.

Received June 23, 2006. Accepted for publication August 19, 2006.

Acknowledgments: We are indebted to the patient for permitting publication of his case and photographs, and to Roberto Sud for technical assistance.

Financial support: This study was supported by the Ministry of Education, Science, Culture and Sports of Japan (grants no. 14256002 and 18256004).

* Address correspondence to Manuel Calvopina, Department of Parasitology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan. E-mail: mcalvopina{at}hotmail.com

Authors’ addresses: Manuel Calvopina and Yoshihisa Hashiguchi, Department of Parasitology, Kochi Medical School, Kochi University, Kochi 783-8505, Japan, Telephone: 81-88-880-2417, Fax: 81-88-880-2415, E-mails: mcalvopina{at}hotmail.com and hashiguy{at}med.kochi-u.ac.jp. Eduardo A. Gomez, Departamento de Epidemiologia, Instituto Nacional de Higiene y Medicina Tropical Leopoldo Izquieta Perez, Apartado 10833, Guayaquil, Ecuador, Telephone and fax: 593-42-362709, E-mail: egolandires{at}yahoo.es. Herbert Sindermann, Medical Research and Development, Zentaris GmbH, Weismuellerstrasse 50, 60314 Frankfurt,Germany, Telephone: 49-694-2602-2512, Fax: 49-694-2602-3404, E-mail: herbert.sindermann{at}zentaris.com. Philip J. Cooper, Laboratorio de Investigaciones, Hospital Pedro Vicente Maldonado, Pichincha Province. Casilla 17-14-30. Quito, Ecuador, Telephone: 593-98142216, Fax: 593-22-598009, E-mail: pcooper{at}ecnet.ec.






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Copyright © 2006 by the American Society of Tropical Medicine and Hygiene.