<font color="#000000"><font><font face="verdana,sans-serif">Dear Thor,</font></font></font><div><font color="#000000"><font><font face="verdana,sans-serif">I would try liposomal amphotericin very soon. Visceralization of L. braziliensis would trigger inflammation and rejection.</font></font></font></div>
<div><font color="#000000"><font><font face="verdana,sans-serif">I wonder if miltefosine would be another choice, but I have no notice on its use in transplant patients.</font></font></font></div><div><font color="#000000"><font><font face="verdana,sans-serif">Also, check amphotericin & miltefosine interaction with tacrolimus and micophenolate mofetil.</font></font></font></div>
<div><font color="#000000"><font><font face="verdana,sans-serif">Please let the community know your patient outcome. This will teach everyone a lot.</font></font></font></div><div><font color="#000000"><font><font face="verdana,sans-serif">Best wishes,</font></font></font></div>
<div><font color="#000000"><font><font face="verdana,sans-serif">Carlos. <br></font></font></font><br><div class="gmail_quote">2012/5/16 Thor Dantas <span dir="ltr"><<a href="mailto:thor.mdac@gmail.com" target="_blank">thor.mdac@gmail.com</a>></span><br>
<blockquote class="gmail_quote" style="margin:0 0 0 .8ex;border-left:1px #ccc solid;padding-left:1ex">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).<br>
thanks everybody.<br>
hugs<br>
<span class="HOEnZb"><font color="#888888">Thor Dantas<br>
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</font></span></blockquote></div><br><br clear="all"><div><br></div>-- <br><div style="text-align:left"><span style="font-family:verdana,sans-serif">Carlos H. N. Costa, MD, DSc.</span></div><div style="text-align:left"><span style="font-family:verdana,sans-serif">Sociedade Brasileira de Medicina Tropical </span></div>
<div style="text-align:left"><span style="font-family:verdana,sans-serif"></span><span style="font-family:verdana,sans-serif">(Brazilian Society of Tropical Medicine)</span></div><div style="text-align:left"><span style="font-family:verdana,sans-serif">President</span></div>
<div style="text-align:left"><span style="font-family:verdana,sans-serif"><br></span></div><div style="text-align:left"><span style="font-family:verdana,sans-serif">Universidade Federal do Piauí</span></div><div><div style="text-align:left">
<span style="font-family:verdana,sans-serif">Instituto de Doenças Tropicais Natan Portella</span></div><div style="text-align:left"><font face="verdana, sans-serif">Rua Artur de Vasconcelos 151-Sul</font></div><div><div style="text-align:left">
<span style="font-family:verdana,sans-serif">64001-450 Teresina-PI</span></div><font face="verdana, sans-serif"><div style="text-align:left">Brazil</div><div style="text-align:left">Telephones: +55 86 3222-4377 (W), <div style="text-align:center;display:inline!important">
<div style="text-align:center;display:inline!important">+55 86 3221-3062 (W), </div></div><div style="text-align:center;display:inline!important">+55 86 3237-1075 (R). </div></div><div style="text-align:left"><br></div><div style="text-align:left">
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