[Leish-l] miltefosine for diffuse leishmaniasis

[Carlos Costa]

Dear all,

Maria Cleudimar has cutaneous diffuse leishmaniasis due to *Leishmania
amazonensis*. She used to be a long time patient form Dr. Jackson Costa, in
the countryside of Maranhão State, Brazil, since she was 10 years old, after
a disease that started when she was just five. Now, she is under my and
Dorcas care, at the age of 30, living in the city of Teresina.

Her long time DCL does not respond to the treatment antimonium anymore.
Although we still prescribe liposomal amphotericin B at very low dose
(3mg/kg/once a week), her situation is deteriorating progressively, her
renal function does not allow any additional dosing since creatinine is
presently above 3mg/dL, and previous biopsy had shown tubular damage
apparently secondary to the drug, without evidence of amyloidosis. We tried
several combinations of different drugs, without success. Her situation
worsened a lot during her recent pregnancy (the baby is eight months old
now).

Our hope now stands only in miltefosine, for oral chronic use, but the drug
is not licensed or available in Brazil yet (to my knowledge).

With her permission I attached some of her pictures, hoping to sensitize
critical people in order to help me to get miltefosine and the permission
for prescription in Brazil (or any other oral drug with promising efficacy,
and without nephrotoxicity, if known). Moreover, we need to know about the
dose adjustment for the renal impairment, and how long the drug could safely
be used.

One picture shows her face before treatment, and another after the
pregnancy, with the baby. One shows the situation of her thighs, another the
calf of the leg and the last one the infiltration of the palate.

Hoping a little from friends, my kindest regards,

Carlos.

PS. Please understand that the pictures are allowed not for publication or
public presentation. Cleudimar permission is restricted to this forum.


-- 
*Carlos H. N. Costa, MD, DSc.*
*President*
*Sociedade Brasileira de Medicina Tropical *
***(Brazilian Society of Tropical Medicine)*
*Instituto de Doenças Tropicais Natan Portella
Universidade Federal do Piauí*
*Rua Artur de Vasconcelos 151-Sul*
*64049-750 Teresina-PI
Brazil
Telephones: +55 86 3221-3413 (work); +55 86 8838-3303 (mobile).
*
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