Treatment of Complex Cutaneous Leishmaniasis with Liposomal Amphotericin B

Abstract

Background: There is no consensus for the best treatment of complex cutaneous leishmaniasis (CL). We aimed to describe a cohort of CL, focusing on liposomal amphotericin B (L-AmB) treatment outcome.

Methods: We performed a retrospective study in Vall d'Hebron University Hospital (Barcelona, Spain). All patients with parasitologically proven CL diagnosed from 2012 to 2018 were included.

Results: The analysis included 41 patients with CL. The median age was 39 years (IQR 12- 66); 12 (29%) were children, and 29 (71%) were men. Regarding treatment, 24 (59%) received local treatment, whereas 17 (41%) had complex CL and were offered intravenous systemic treatment. Sixteen patients received L-AmB; eight (50%) had adverse events, and three (19%) discontinued treatment for safety reasons. All cases were considered cured within the first year post-treatment.

Conclusions: L-AmB for complex CL showed no treatment failures, offering an alternative treatment option for patients with complex CL. Clinicians should pay close attention to the potential adverse events of L-AmB and adopt an active drug safety surveillance scheme to rapidly detect reversible side effects.

Keywords: complex cutaneous leishmaniasis; cutaneous leishmaniasis; leishmania; liposomal amphotericin B; systemic therapy.

Figure 1

Images of four ulcers from different patients with complex features. (A): Hyperkeratotic and ulcerated plaque on the right hand from a patient with multifocal cutaneous leishmaniasis. (B): Hyperkeratotic 15 centimeters- plaque on the back. (C): Indurated plaque at the nasal root. (D): Subcutaneous nodules due to local dissemination on the right arm.

Figure 2

Kidney function test at different time points in patients treated with L-AmB. Glomerular filtrate (mL/min/1.73m²), time points—before treatment, immediately post-treatment and 1 month after treatment onset.