Open Access Case report

Recurrent visceral leishmaniasis in an immunocompetent patient: a case report

Maria Lagadinou1, Dimitra Dimitropoulou2, Stelios F Assimakopoulos1*, George Davoulos1 and Markos Marangos2

Author Affiliations

1 Department of Internal Medicine, University Hospital of Patras, Rion-Patras 26504, Greece

2 Division of Infectious Diseases, Department of Internal Medicine, University Hospital of Patras, Rion-Patras 26504, Greece

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Journal of Medical Case Reports 2013, 7:68  doi:10.1186/1752-1947-7-68

Published: 14 March 2013

Abstract

Introduction

Current treatment options for visceral leishmaniasis (pentavalent antimony, amphotericin B, liposomal amphotericin B and mitelfosine) achieve long-term clinical cure in the majority of immunocompetent patients. Disease relapse is usually provoked by T-cell number or function impairment (corticosteroid or cytotoxic therapy, transplant recipients, advanced human immunodeficiency virus disease).

Case presentation

We report a case of visceral leishmaniasis with multiple relapses in a 75-year-old Greek immunocompetent man. Visceral leishmaniasis relapses occurred despite appropriate treatment with liposomal amphotericin B 3mg/kg/day on days one to five, 14 and 21 (for the first episode and the first relapse) and mitelfosine 150mg/day for 28 days (for the second relapse). The third relapse was treated with high-dose liposomal amphotericin B (10mg/kg for two consecutive days), followed by a secondary prophylaxis of 3mg/kg once per month, which prevented disease reappearance during one year of follow-up.

Conclusion

An unusual case of recurrent visceral leishmaniasis in an older immunocompetent patient was treated with high-dose liposomal amphotericin B and a monthly prophylaxis with no evidence of a relapse after one year of follow-up.

Keywords:
Leishmaniasis; Recurrent; Immunocompetent; Liposomal amphotericin B