Case Report: Intravenous Pentamidine Rescue Treatment for Active Chronic Visceral Leishmaniasis in an HIV-1 Infected Patient

Flavia Chechi Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy;

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Paola Corsi Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy;

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Dario Bartolozzi Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy;

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Giovanni Gaiera Clinic of Infectious Diseases, Vita-Salute San Raffaele University, Milan, Italy;

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Alessandro Bartoloni Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy;
Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy;
Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy

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Lorenzo Zammarchi Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy;
Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy;
Referral Center for Tropical Diseases of Tuscany, Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy

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ABSTRACT.

The management of visceral leishmaniasis (VL) in HIV-infected patients is complex because of high mortality rates, toxic drug-related side effects, and a high risk of treatment failure and relapse. We report a case of active chronic VL in an HIV-1-infected woman presenting multiple secondary VL episodes over 7 years leading to massive splenomegaly and blood transfusion–dependent anemia despite several treatment courses and secondary prophylaxis. The patient was finally successfully treated with rescue treatment based on intravenous pentamidine. Twenty months after discontinuation of pentamidine the patient presented complete clinical and parasitological response. In patients with active chronic VL, treatment with intravenous pentamidine can be effective and should be considered as rescue treatment.

Author Notes

Address correspondence to Lorenzo Zammarchi, Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy, Largo Brambilla 3, 50134, Firenze, Italia. E-mail: lorenzo.zammarchi@unifi.it

Financial support: This work was supported by funds of “Ministry of Education, University and Research (Italy) Excellence Departments 2018–2022” Project for the Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.

Authors’ addresses: Flavia Chechi, Università degli Studi di Firenze, Infectious and Tropical Diseases, Firenze, Italy 50121, E-mail: flavia.chechi@unifi.it. Paola Corsi and Dario Bartolozzi, Azienda Ospedaliero Universitaria Careggi, Infectious and Tropical Diseases Unit, Firenze, Toscana, Italy, E-mails: corsip@aou-careggi.toscana.it and bartolozzid@aou-careggi.toscana.it. Giovanni Gaiera, Universita Vita e Salute San Raffaele, Clinic of Infectious Diseases, Milano, Lombardia, Italy, E-mail: galera.gio@gmail.com. Alessandro Bartoloni, University of Florence, Infectious and Tropical Diseases, Largo Brambilla 3, Florence, Italy 50134, E-mail: alessandro.bartoloni@unifi.it. Lorenzo Zammarchi, Università di Firenze, Clinica Malattie Infettive, Dipartimento di Medicina Sperimentale e Clinica, Florence, Italy, E-mail: lorenzo.zammarchi@unifi.it.

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