Successful treatment of Old World cutaneous leishmaniasis caused by Leishmania infantum with posaconazole

Abstract

Old World cutaneous leishmaniasis is a widespread and potentially disfiguring protozoal infection that is endemic in the Mediterranean basin, Africa, and parts of Asia. Human infection is caused by several species of Leishmania parasites, such as Leishmania infantum. Available systemic and topical treatments vary in efficacy and are often unjustified due to their toxicity. We report on a case that was treated with posaconazole, a drug typically considered an antifungal agent but which also targets specific metabolic pathways of the parasite.

FIG. 1.

(A) Diffuse mixed granulomatous dermal infiltrate, mainly lymphoid-histiocytic (hematoxylin and eosin stain; magnification, ×20). (B) Clusters of basophilic microorganisms (amastigotes) within the histiocytes (hematoxilin and eosin stain; magnification, ×60). Inset, amastigotes within a vacuolated histiocyte. The nuclei of L. infantum are clearly visible (Giemsa stain; magnification, ×100).

FIG. 2.

Species identification by ITS1 PCR-restriction fragment length polymorphism analysis with HaeIII enzyme digestion. Lanes: 1 and 7, 1-kb and 10-bp DNA ladders, respectively; 8, undigested ITS1 PCR product; 2, strain MHOM/US/2010/SLRCHCL isolated from the patient with CL; 3 to 6, reference strains belonging to different Leishmania species (L. aethiopica [MHOM/ET/1994/Gere], L. tropica [MHOM/PS/2001/ISL590], L. infantum [MHOM/ES/1993/PM1], and L. donovani [MHOM/SD/1993/LEM338], respectively).