A Case of Cutaneous Leishmaniasis Cured by a Combined Treatment of Topical Miltefosine and Injectable Amphotericin B

Abstract

A male rural worker with cutaneous leishmaniasis (CL) was initially treated with repeated cycles of Me-glumine Antimoniate (Glucantime®) and two cycles of Amphotericin B deoxycholate during a three-year period. However, the patient remained with two active lesions. An experimental topical treatment with liposomal Miltefosine was tested. The efficacy was determined from the MD’s inspection of the patient and analysis of the lesions’ photographic images, lesions samples culture, and anti-Leishmania antibodies quan-tification. The parasites from the patient were isolated. The parasites were typified as Leishmania braziliensis, and their susceptibility to Miltefosine, Meglumine Antimoniate, and Amphotericin B was measured. The wound healing was initially good with the topical treatment, but the clinical cure was achieved only with a combination of the topical liposomal Miltefosine and intravenous Amphotericin B. Of note, the treatment efficacy was strongly correlated with the degree of stress suffered by the patient. To our knowledge, this is the first report on using a topical Miltefosine formulation on a CL patient.