Lavilla P, Dupla JM, Pintado V, Valencia E, Martin A, Martinez P, Gil A; International Conference on AIDS.
Int Conf AIDS. 1992 Jul 19-24; 8: B120 (abstract no. PoB 3203).
Hospital La Paz, Universidad Autonosa, Madrid, Spain.
OBJECTIVE: Relapses of visceral leishmaniasis are usually seen in HIV infected patients. Antimonial compounds are the drugs of choice to initial therapy for it. Pentamidine, amphotericin B, allopurinol and interferon-gamma are other effective treatments. The new liposomal amphotericin B formulation, a less toxic preparation, has been successfully used in a few cases of visceral leishmaniasis resistant to other drugs. We report a case of relapsing visceral leishmaniasis associated to HIV infection treated successfully with liposomal amphotericin B because of toxicity and failure to megluaine antimoniate and pentamidine. METHODS: A 28 year old man was admitted to the hospital in June 1989 because of fever, hepatosplenomegaly, anemia and hypergammaglobulinemia. He was diagnosed of visceral leishmaniasis by bone marrow aspiration. There was a history of intravenous drug use, chronic persistent hepatitis and HIV infection. He received a 850 mg daily megluaine antimoniate course that was discontinued after 15 days of treatment because of renal failure and it was changed to pentamidine isethionate. He had 3 more relapses of visceral leishmaniasis and he responded to other 2 courses of pentamidine (250 mg daily during 21 days) and to one of pentamidine plus allopurinol (250 mg and 900 mg daily, respectively, during 21 days). He was admitted again in May 1991 because of a new apparent relapse although no evidence of Leishmania amastigotes in the histologic examination and culture study of bone marrow and hepatic biopsy was seen. Other infections were excluded. He did not respond to a new course of pentamidine and showed a renal function impairment. Pentamidine was changed to liposomal amphotericin B (50-100 mg/daily; total dose 1400 mg in 12 days). The patient was afebrile in three days, his spleen had shrunk and the renal function ameliorated. He had no drug adverse effects. A prophylactic schedule with liposomal amphotericin B (150 mg twice a month) was started. The patient was asymptomatic 6 months later. CONCLUSION: Liposomal amphotericin B may be an alternative therapy for visceral leishmaniasis in patients with toxicity or resistance to antimonial compounds and pentamidine. A suppressive therapy with liposomal amphotericin B may be useful in relapsing leishmaniasis of HIV infected patients.
Publication Types:
Keywords:
- Acquired Immunodeficiency Syndrome
- Amphotericin B
- Drug Toxicity
- HIV Seropositivity
- Humans
- Leishmania
- Leishmania donovani
- Leishmania infantum
- Leishmaniasis, Visceral
- Liposomes
- Male
- Pentamidine
- toxicity
Other ID:
UI: 102198649
From Meeting Abstracts