A Case of American 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 cy-cles of Meglumine Antimoniate (Glucantime®) and two cycles of Amphotericin B deoxycholate during a three-year period. However, the patient remained with two active lesions. An experi-mental 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, le-sions samples culture, and anti-Leishmania antibodies quantification. The parasites from the patient were isolated. The parasites were typified as Leishmania (Viannia) braziliensis, and their susceptibility to Miltefosine, Meglumine Antimoniate, and Amphotericin B was measured. The wound healing was initially good with the topical treat-meant, 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 corre-lated 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.