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  • Núcleo de Medicina Tropical e Nutrição University of Brasília and Hospital Profesor Edgard Santos, Salvador, Bahia, Brasil

We recently reported apparent cure of a difficult treatment problem in a patient with mucosal leishmaniasis due to Leishmania braziliensis braziliensis (L. b. b.) in the Journal. This patient had relapsed after many courses of antimonial therapy and 2.5 g total dose of amphotericin B, but was apparently cured with 85 days continuous treatment at a daily dose of 20 mg Sbv/kg/day of Pentostam. As stated in our recent paper, after 2 years follow-up no evidence of clinical activity of the disease was recorded, and fluorescent antibody titer had fallen to 1:40 9 months after treatment.

Follow-up continued, however, and 27 months later a titer of 1:320 was recorded. Our protocol calls for further clinical examination in such circumstances and the patient was traced and examined 31 months after the final treatment. Examination of the nose and mouth showed indisputable signs of recurrence; two large granulomatous masses (2–3 cm) were present on the nasal septum.