(Last Updated On: April 2, 2019)
Authors: Audi, MD, Ailza Bellamy R. Limcangco, MD, FPDS, Johannes F, Dayrit, MD, FPDS

Abstract

Introduction: Cutaneous leishmaniasis is non-endemic in the Philippines. Antiparasitic pentavalent antimonials are acknowledged as first-line therapy for all forms of the disease. Amphotericin B is the second drug of choice but its use is limited due to side effects.

Case Summary: We present a case of a 32- year-old male overseas Filipino worker who presented with “volcaniform plaques” (nodules and plaques with central crater) and surrounding satellite erythematous papules on the trunk, and extremities after returning from Iraq. A diagnosis of cutaneous leishmaniasis was confirmed by the histopathologic findings of a granulomatous inflammatory infiltrate with round to oval basophilic structures in the cytoplasm of macrophages (Leishman bodies) in the dermis, which were highlighted prominently by Giemsa stain. The patient showed
poor response to treatment with 4 weeks of oral Rifampicin 1200 mg daily divided into 2 doses. He was shifted to oral Itraconazole 400 mg daily divided into 2 doses for 6 weeks with dramatic improvement.

Conclusion: This case report highlights the favorable therapeutic response of cutaneous leishmaniasis to oral itraconazole and hence, may be recommended as first-line medication to treat infected overseas workers from endemic areas who seek treatment in the Philippines.

 

Citation

Audi, Limcangco AB, Dayrit J. Cutaneous leishmaniasis in an overseas Filipino worker who responded favorably to oral itraconazole. J Phil Dermatol Soc. 2018; 27(2): 86-90.

 

Keywords

Cutaneous, Leishmaniasis, Oral Itraconazole.

1. Koliou MG, Antoniou Y, Antoniou M, Christodoulou V, Mazeris A, Soteriades ES. A cluster of four cases of cutaneous leishmaniasis by Leishmania donovani in Cyprus : a case series. J Med Case Rep. 2014;8(354):2-4.

2. Vries HJC De, Reedijk SH, Schallig HDFH. Cutaneous Leishmaniasis : Recent Developments in Diagnosis and Management. Am J Clin Dermatol. 2015;16:99-109. doi:10.1007/s40257-015-0114-z

3. Centers for Disease Control and Prevention. US Department of Health & Human Services. Parasites- – Leishmaniasis. https://www.cdc.gov/parasites/leishmaniasis/epi.html. Published 2013. Accessed September 25, 2018.

4. World Health Organization. Leishmaniasis. http://www.who.int/news- room/fact-sheets/detail/leishmaniasis. Published 2018. Accessed September 25, 2018.

5. Handler MZ, Patel PA, Kapila R. Cutaneous and mucocutaneous leishmaniasis. J Am Dermatology. 2015;73(6):897-908. doi:10.1016/j.jaad.2014.08.051

6. Aronson N, Herwaldt BL, Libman M, et al. Diagnosis and Treatment of Leishmaniasis : Clinical Practice Guidelines by the Infectious Diseases Society of America ( IDSA ) and the American Society of Tropical Medicine and Hygiene ( ASTMH ). 2016;63(12):202-264. doi:10.1093/cid/ciw670

7. Pierre Buffet, Gloria Morizot, Lama Jalouk, Mourad Mokni Badderedin Annajar, Reza Shirzadi, Jose A. Ruiz-Postigo RB-I. Manual for Case Management of Cutaneous Leishmaniasis in the WHO Eastern Mediterranean Region. 35th ed. World Health Organization. Regional Office for the Eastern Mediterranean; 2014.

8. Mcgwire BS, Satoskar AR. Leishmaniasis: Clinical syndromes and treatment. Q J Med. 2014;107:7-14. doi:10.1093/qjmed/hct116

9. Amato VS, Padilha ARS, Nicodemo AC, et al. Use of Itraconazole in the Treatment of Mucocutaneous Leishmaniasis : A Pilot Study. Int J Infect Dis. 2000;4:153-157.

10. Oliveira PRS, Dessein H, Romano A, et al. IL2RA Genetic Variants Reduce IL-2 − Dependent Responses and Aggravate Human Cutaneous Leishmaniasis. J Immunol. 2015;194:2664–2672. doi:10.4049/jimmunol.1402047

11. Mougneau E, Bihl F GN. Cell biology and immunology of Leishmania. Immunol Rev. 2011;240(1):286-296. doi:10.1111/j.1600-065X.2010.00983.x

12. Murray HW, Berman JD, Davies CR, Saravia NG. Advances in leishmaniasis. Lancet. 2005;366:1561-1577.

13. Macedo-silva ST De, Urbina JA, Souza W De, Cola J. In Vitro Activity of the Antifungal Azoles Itraconazole and Posaconazole against Leishmania amazonensis. PLoS One. 2013;8(12):e83247. doi:10.1371/journal.pone.0083247

14. Consigli J, Danielo C, Gallerano V, Papa M, Guidi A. Tropical medicine rounds Cutaneous leishmaniasis : successful treatment with itraconazole. Int J Dermatol. 2006;45:46-49.

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