[Tropmed-l] Tegumentar Leishmaniasis in liver transplant

[Carlos Costa]

Dear Thor,
I would try liposomal amphotericin very soon. Visceralization of L.
braziliensis would trigger inflammation and rejection.
I wonder if miltefosine would be another choice, but I have no notice on
its use in transplant patients.
Also, check amphotericin & miltefosine interaction with tacrolimus and
micophenolate mofetil.
Please let the community know your patient outcome. This will teach
everyone a lot.
Best wishes,
Carlos.

2012/5/16 Thor Dantas <thor.mdac em gmail.com>

> Dear colleagues, I have a liver transplant patient for 5 months in use of
> FK and MMF with a rapid progressive tegumentar leishmaniasis in the face.
> does anyone have anyexperience in treating this scenario. Furthermore, the
> patient has diabetes and hypertension and is admitted to the hospital
> because of intenseasthenia and peripheral neuropathy. Also shows marked
> elevation of liver enzymes wich is under investigation. a liver biopsy is
> planned. The main hypotheses are FK toxicity and/or post transplant
> recurrence of HCV. (rejection seems less likely because the serum level was
> pretty high).
> thanks everybody.
> hugs
> Thor Dantas
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-- 
Carlos H. N. Costa, MD, DSc.
Sociedade Brasileira de Medicina Tropical
(Brazilian Society of Tropical Medicine)
President

Universidade Federal do Piauí
Instituto de Doenças Tropicais Natan Portella
Rua Artur de Vasconcelos 151-Sul
64001-450 Teresina-PI
Brazil
Telephones: +55 86 3222-4377 (W),
+55 86 3221-3062 (W),
+55 86 3237-1075 (R).


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