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

MANUEL CALVOPINA 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

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EDUARDO A. GOMEZ 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

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HERBERT SINDERMANN 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

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PHILIP J. COOPER 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

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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

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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.

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