Successful treatment of diffuse cutaneous leishmaniasis caused by Leishmania amazonensis

Abstract

Diffuse cutaneous leishmaniasis is a rare universal disease associated with an inadequate host cell immune response, caused by different species: infantum , aethiopica, major , mexicana, and others, which presents the challenge of a poor therapeutic response. In Brazil, it is caused by L. amazonensis . A case confirmed by histopathology with an abundance of vacuolated macrophages full of amastigotes and lymphocyte scarcity, identified by RFLP-ITS1PCR and in vitro decrease and exhaustion of the host cell immune response to L. amazonensis antigen, was treated early (3 months after the onset) with Glucantime (2 months) and allopurinol (29 months) with clinical cure, after a follow-up for 30 months after treatment.

The Extraordinary Case of a Woman with a 30-Year-Long Diffuse Leishmaniasis Cured with One Single Ampoule of Intranasal Pentavalent Antimoniate

“…However, the most enigmatic fact, in this case, was the unexpected sudden clinical and parasitological response to the last rescue treatment. Although DCL caused by L. amazonensis , L. mexicana , and L. aethiopica is curable, albeit challenging [ 16 , 17 , 18 ], this patient was an extreme case: numerous and prolonged treatments had failed, and she was cured after a single ampoule of Sb V applied topically on the nasal mucosa. If resistance mechanisms to antimoniates existed, like lower drug accumulation, lower drug internalization, lower trypanothione concentration, and a lower rate of reduction of Sb V to the trivalent form (Sb III ), they were overcome [ 16 ].…”

Humoral response in Leishmaniasis

“…LCL is the mildest form of leishmaniasis, its clinical manifestation is characterized by one or multiple lesions that can ulcerate in exposed parts of the body, usually rounded and with raised edges ( Gontijo and de Carvalho, 2003 ). DCL is the least common form ( Sampaio et al., 2021 ), characterized by the development of multiple nodules without ulceration that can affect the entire body. ML is a form restricted to Latin America, after skin lesions, the disease spreads to the mucous membrane of the nose, mouth, and throat, where subsequently there is the formation of ulcers in the mucosa that destroy the nasal septum, lips, and nose.…”