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Amato VS, Tuon FF, Siqueira AM, Nicodemo AC, Amato Neto V, 2007. Treatment of mucosal leishmaniasis in Latin America: systematic review. Am J Trop Med Hyg 77: 266–274.
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Amato VS, Tuon FF, Camargo RA, Souza RM, Santos CR, Nicodemo AC, 2011. Can we use a lower dose of liposomal amphotericin B for the treatment of mucosal American leishmaniasis? Am J Trop Med Hyg 85: 818–819.
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Reactivation of Mucosal and Cutaneous Leishmaniasis in a Renal Transplanted Patient
Mucosal leishmaniasis (ML) is a chronic form of tegumentary leishmaniasis, which causes destructive lesions of nasal, pharyngeal, and laryngeal mucosa. We describe a case of leishmaniasis reactivation with simultaneous cutaneous and mucosal forms in a renal transplanted patient with no history of prior leishmaniasis. Reactivation after renal transplantation was not reported in Brazil. A 67-year-old woman receiving prednisone 20 mg/day, tacrolimus 1 mg/day, and mycophenolic acid 360 mg/day presented with nose edema with erythema and cutaneous lesions. Amastigotes were identified on biopsies and the polymerase chain reaction confirmed Leishmania (Viannia) braziliensis. The patient was treated with liposomal amphotericin B but died 3 weeks after as a result of bacterial septic shock. In conclusion, tegumentary leishmaniasis can reactivate with simultaneous cutaneous and mucosal forms in a renal transplanted patient during the immunosuppressant therapy.
Author Notes
Authors' addresses: Felipe Tuon, Universidade Federal do Parana, Division of Infectious Diseases, Curitiba, Parana, Brazil, E-mail: flptuon@gmail.com. Giovana Marina Bombonatto, Eveline Roesler Battaglin, and Marcus Henrique Sakumoto, Hospital Universitário Evangélico de Curitiba, Division of Infectious and Parasitic Diseases, Curitiba, Parana, Brazil, E-mails: gibombonatto@gmail.com, everoesler@uol.com.br, and marcushenrique@hotmail.com. Valdir Sabbaga Amato, University of Sao Paulo, Department of Infectious and Parasitic Diseases, School of Medicine Alameda Gabriel Monteiro da Silva, Sao Paulo, Brazil, E-mail: valdirsa@netpoint.com.br. Raphael Abegão de Camargo, Department of Infectious Diseases, University of São Paulo, Medical School, São Paulo, Brazil, E-mail: raphabegao@yahoo.com.br. Antônio Carlos Nicodemo, University of Sao Paulo, Department of Infectious Diseases, Sao Paulo, Brazil, E-mail: ac_nicodemo@uol.com.br.