Keratitis occurring in patients treated with miltefosine for post-kala-azar dermal leishmaniasis

Abstract

AimTo describe the characteristic clinical features and management of keratitis in the patients receiving miltefosine for post-kala-azar dermal leishmaniasis (PKDL).MethodsThe medical records of five patients with PKDL who presented with keratitis were reviewed retrospectively from April 2018 to December 2019. The evaluation included a thorough medical history including details on drugs used, particularly miltefosine. The drug causality assessment was also performed. The clinical and microbiological characteristics of keratitis were noted.ResultsThe ocular symptoms included pain, redness, watering, photophobia and diminution of vision. Slit-lamp biomicroscopy revealed peripheral, paralimbal, ring-shaped, full-thickness stromal infiltration resulting in ulcerative keratitis in all cases. Two patients had unilateral keratitis, while three had bilateral keratitis. All five patients received miltefosine for an average period of 48 days before the onset of keratitis. The corrected distance visual acuity at presentation ranged from hand movement to 20/125. The causality assessment revealed a ‘probable’ association between the adverse drug reaction and miltefosine in all patients. Discontinuation of miltefosine and initiation of corticosteroid therapy resulted in resolution of keratitis in all cases. The unilateral keratitis treated with topical corticosteroids had improved outcomes, but poor outcomes were found in the bilateral keratitis.ConclusionThese observations indicate that prolonged use of miltefosine might cause keratitis that resembles infectious keratitis. Early diagnosis with discontinuation of the drug and initiation of corticosteroid therapy are the key to successful management.

Immune recovery-related patterns of post kala-azar dermal and ocular leishmaniasis in people living with HIV

“…PKDL uveitis exposes to a risk of sequelar blindness [38]. Recent reports suggest ocular disease in PKDL can also be due to an adverse drug reaction to miltefosine [39][40][41]. Mucosal lesions affecting genitalia might expose to a higher risk of HIV transmission [42].…”

Safety and efficacy of paromomycin/miltefosine/liposomal amphotericin B combinations for the treatment of post-kala-azar dermal leishmaniasis in Sudan: A phase II, open label, randomized, parallel arm study

“…A more detailed comparison of pharmacokinetic characteristics between these two patient populations may bring some insight into this difference, which might also be explained by the overall condition of patients with PKDL, with better nutritional status and less risk of other co-morbidities. Finally, recently there has been a lot of attention given to the risk of ocular toxicity, mainly associated with the 12-week MF therapy for PKDL in South Asia [40][41][42]. In Sudan, post-kala-azar ocular leishmaniasis has been described by Prof. EL-Hassan et al concomitantly with PKDL [36], with presentations of conjunctivitis and uveitis.…”