Resistance to Intramuscular Meglumine Antimoniate in Cutaneous Leishmaniasis

Abstract

Leishmaniasis is a disease caused by protozoan parasites of the genus Leishmania. It is classified as: cutaneous, mucocutaneous and visceral. Of the above, cutaneous leishmaniasis (CL) is the most common form worldwide, transmitted to humans by the bite of the female mosquito, which belongs to the Phlebotominae and Lutzomyia family. The skin generally manifests clinically by presenting an ulcerated papule with serous exudate, with a clean, granular-looking background and hyperemic and thickened edges.
We present the case of a 16-year-old adolescent, from Aldea Peña Blanca Norte, San Pedro Sula, with an erythematous-crusted, non-painful swelling lesion of 2 months' duration, in the right ear. The patient was seen in the Pediatric Dermatology outpatient clinic of the Honduran Institute of Northern Regional Social Security (I.H.S.S.), receiving treatment with systemic and topical antibiotics (trimethoprim sulfamethoxazole, mupirocin ointment), for 7 days. He had previously received several oral and parenteral systemic treatments (amoxicillin/clavulanic acid, dicloxacillin, benzathonic penicillin, and topical application of fusidic acid) without obtaining any clinical improvement; he was sent to perform direct microscopy with Giemsa stain of a smear obtained from the lesion at the “Miguel Paz Barahona” Health Center, demonstrating the presence of amastigotes. Meglumine antimoniate was started according to the scheme established by the World Health Organization (WHO) at a rate of 20 mg/kg/day intramuscularl for 30 days. Due to treatment failure, it was decided to use itraconazole for 3 months with a good response and no adverse effects.