Post-Kala-Azar Dermal Leishmaniasis in an HIV-1–Infected Woman: Recovery after Amphotericin B Following Failure of Oral Miltefosine

Monica Guffanti Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy; STD Centre-Institute of Dermatological Sciences, IRCCS Ospedale Maggiore, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy

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Giovanni Gaiera Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy; STD Centre-Institute of Dermatological Sciences, IRCCS Ospedale Maggiore, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy

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Simona Bossolasco Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy; STD Centre-Institute of Dermatological Sciences, IRCCS Ospedale Maggiore, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy

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Norberto Ceserani Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy; STD Centre-Institute of Dermatological Sciences, IRCCS Ospedale Maggiore, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy

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Deborah Ratti Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy; STD Centre-Institute of Dermatological Sciences, IRCCS Ospedale Maggiore, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy

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Paola Cinque Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy; STD Centre-Institute of Dermatological Sciences, IRCCS Ospedale Maggiore, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy

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Flavia Salmaso Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy; STD Centre-Institute of Dermatological Sciences, IRCCS Ospedale Maggiore, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy

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Nicola Gianotti Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy; STD Centre-Institute of Dermatological Sciences, IRCCS Ospedale Maggiore, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy

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Adriano Lazzarin Clinic of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy; STD Centre-Institute of Dermatological Sciences, IRCCS Ospedale Maggiore, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy

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We describe a case of post-kala-azar dermal leishmaniasis occurring after diagnosis of visceral leishmaniasis in an HIV-1–infected woman. The skin lesions did not recover after treatment with oral miltefosine at 100 mg/day for five cycles of 28 days but responded to treatment with liposomal amphotericin B.

Author Notes

  • 1

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    Sindermann H, Engel KR, Fischer C, Bommer W for the Miltefosine Compassionate Use Program, 2004. Oral miltefosine for leishmaniasis in immunocompromised patients: compassionate use in 39 patients with HIV infection. Clin Infect Dis 39 :1520–1523.

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    Rihl M, Stoll M, Ulbricht K, Bange FC, Schmidt RE, 2006. Successful treatment of post-kala-azar-dermal leishmaniasis (PKDL) in a HIV infected patient with multiple relapsing leishmaniasis from Western Europe. J Infect 53 :e25–e27.

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    Dejenie Belay A, Asafa Y, Mesure J, Davidson RN, 2006. Successful miltefosine treatment of post-kala-azar-dermal leishmaniasis occurring during antiretroviral treatment. Ann Trop Med Parasitol 100 :223–227.

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    Sundar S, Kumar K, Chakravarty J, Agrawal D, Agrawal S, Chhabra A, Singh V, 2006. Cure of antimony-unresponsive Indian post-kala-azar dermal leishmaniasis with oral miltefosine. Trans R Soc Trop Med Hyg 100 :698–700.

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  • 12

    Bossolasco S, Gaiera G, Olchini D, Gulletta M, Martello L, Bestetti A, Bossi L, Germagnoli L, Lazzarin A, Uberti-Foppa C, Cinque P, 2003. Real-time PCR assay for clinical management of human immunodeficiency virus-infected patients with visceral leishmaniasis. J Clin Microbiol 41 :5080–5084.

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    Soto J, Toledo J, Gutierrez P, Nicholls RS, Padilla J, Engel J, Fischer C, Voss A, Berman J, 2001. Treatment of American cutaneous leishmaniasis with miltefosine, an oral agent. Clin Infect Dis 33 :57–61.

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    Pérez-Victoria FJ, Sánchez-Cañete MP, Seifert K, Croft SL, Sundar S, Castanys S, Gamarro F, 2006. Mechanism of experimental resistance of Leishmania to miltefosine: implications for clinical use. Drug Resist Updat 9 :26–39.

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  • 15

    Berman J, Bryceson ADM, Croft S, Engel J, Gutteridge W, Karbwang J, Sindermann H, Soto J, Sundar S, Urbina JA, 2006. Miltefosine: issues to be addressed in the future. Trans R Soc Trop Med Hyg 100S :S41–S44.

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  • 16

    Sindermann H, Engel J, 2006. Development of miltefosine as an oral treatment for leishmaniasis. Trans R Soc Trop Med Hyg 100S :S17–S20.

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