Diabetes melutus associated with pentamidine isethionate in diffuse cutaneous leishmaniasis

Abstract

The authors report a case o f a male patient from Bacabal, MA with diffuse cutaneous leishmaniasis (DCL) Diffuse cutaneous leishmaniasis (DCL) is a rare form of cutaneous leishmaniasis in which cellular immunity to leishmania antigens is absent and which shows a poor response to antileishmanial agents. According to Silva12, who originally described the disease in Brazil, initial lesions are macular, papular or nodular containing abundant parasites. Regional lymphadenopathy and mucosal lesions are uncommon and visceral lesions unreported5.The disease begins as a nodule, to spread locally and distally to the rest of the skin. Although the Montenegro skin test is negative, ind icatin g a lack o f cellu lar imm unity to leishmania antigens, DCL patients do respond to unrelated skin test antigens such as PPD and candidin3 5. patients was cured with primaquine 30mg per day for 2 months, and did not relapse over 14 months. This case probably shows that the rare case of diffuse disease with only one lesion may self heal. Amphotericin B (lmg/kg/for about 2 months) was used in 4 patients. In Peru, pentostam (20mg/sbV/day for 60 days) resulted in improvement but not cure7.In Brazil, the drug of choice for the treatment of mucocutaneous and DCL is the pentavalent antimonial (glucantime®)10 13. If relapse occurs, second line therapy with amphotericin B or pentamidine are indicated. Pentamidine isethionate is not available, being imported from England (pentacarinat® CASE REPORTRNPS, 31 years old, man, landworker, from the state of Maranhão, northeast of Brazil, had DCL caused by Leishmania amazonensis, for at least nine years. During the last three years, he was submitted to various therapy schedules (glucantime®, amphotericin B, g lu c a n tim e ® p lu s g a m m a -in te r fe r o n ), 405

Characteristics of Interferon-Associated Diabetes Mellitus in Past 30 Years: A Review

“…Patients were evaluated for clinical characteristics such as age, sex, IFN type, ribavirin use, treatment duration of IFN before the onset of diabetes, HLA type, and glutamate decarboxylase antibody-positive rate. We retrieved 82 cases of IFN-associated diabetes, including 1 case of our own (Supplementary Material 2) 4 5 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 . According to the consensus report by the ADA and the EASD 57 , we identified all IFN-associated type 1 diabetes cases.…”