Good response to pentamidine isethionate in a case of Mucosal Leishmaniasis caused by Leishmania (Viannia) braziliensis that was difficult to treat: Case Report

Abstract In Brazil, meglumine antimoniate is the first drug of choice for mucosal leishmaniasis treatment followed by amphotericin B and pentamidine isethionate. We report the case of a patient with severe mucosal lesions caused by Leishmania (Viannia) braziliensis that were difficult to treat. Over a 14-year period, the patient showed low adherence and three treatment attempts with meglumine antimoniate failed. Additionally, there was an unsatisfactory response to liposomal amphotericin B and nephrotoxicity when using amphotericin B deoxycholate that persisted after new treatment attempt with liposomal amphotericin B. Finally, healing was achieved with pentamidine isethionate and maintained during nine months of monitoring.

摘要 在巴西，葡甲胺锑酸盐（meglumine antimoniate）是黏膜利什曼病治疗的一线首选药物，后续治疗药物依次为两性霉素B与羟乙磺酸喷他脒（pentamidine isethionate）。本文报告1例由巴西利什曼原虫（Viannia亚属）（Leishmania (Viannia) braziliensis）引发的难治性重度黏膜损害病例。该患者治疗依从性较差，14年病程中先后3次使用葡甲胺锑酸盐治疗均告失败；对脂质体两性霉素B应答欠佳，使用脱氧胆酸两性霉素B时出现肾毒性，且该肾毒性在再次予脂质体两性霉素B治疗后仍持续存在。最终，患者经羟乙磺酸喷他脒治疗后皮损愈合，并在9个月的随访中病情维持稳定。