Case Report: Combination Therapy with Liposomal Amphotericin B, N-Methyl Meglumine Antimoniate, and Pentamidine Isethionate for Disseminated Visceral Leishmaniasis in a Splenectomized Adult Patient
In immunocompromised patients, visceral leishmaniasis (VL) can present with atypical clinical symptoms that include poor response to treatment. No optimal therapeutic regimen is available for such cases. In a splenectomized male patient, we observed a disseminated form of the disease in the liver, b...
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| Veröffentlicht in: | The American journal of tropical medicine and hygiene 2020-02, Vol.102 (2), p.268-273 |
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| creator | Vechi, Hareton Teixeira Sousa, Ana Solange Vasconcelos de Cunha, Mirella Alves da Shaw, Jeffrey Jon Luz, Kleber Giovanni |
| description | In immunocompromised patients, visceral leishmaniasis (VL) can present with atypical clinical symptoms that include poor response to treatment. No optimal therapeutic regimen is available for such cases. In a splenectomized male patient, we observed a disseminated form of the disease in the liver, bone marrow, lymph nodes, and gastrointestinal tract. There was an apparent clinical improvement when he was initially treated with liposomal amphotericin B (L-AmB), but this was followed by a relapse involving severe clinical symptoms. He was finally treated successfully with a combination of L-AmB, meglumine antimoniate, and pentamidine isethionate. It is important to include asplenia as an immunosuppressive condition that induces exotic VL pathologies. In such cases, combination anti-
drug therapy should be considered. |
| doi_str_mv | 10.4269/ajtmh.18-0999 |
| format | Article |
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drug therapy should be considered.</description><subject>Amphotericin B - administration & dosage</subject><subject>Amphotericin B - therapeutic use</subject><subject>Antifungal agents</subject><subject>Antiprotozoal Agents - administration & dosage</subject><subject>Antiprotozoal Agents - therapeutic use</subject><subject>Bone Marrow - parasitology</subject><subject>Case reports</subject><subject>Combination therapy</subject><subject>Drug Therapy, Combination</subject><subject>Humans</subject><subject>Immunocompromised Host</subject><subject>Intestinal Mucosa - parasitology</subject><subject>Leishmaniasis, Visceral - drug therapy</subject><subject>Leishmaniasis, Visceral - immunology</subject><subject>Lymph Nodes - parasitology</subject><subject>Male</subject><subject>Meglumine Antimoniate - administration & dosage</subject><subject>Meglumine Antimoniate - therapeutic use</subject><subject>Middle Aged</subject><subject>Parasitic diseases</subject><subject>Pentamidine - administration & dosage</subject><subject>Pentamidine - therapeutic use</subject><subject>Splenectomy</subject><issn>0002-9637</issn><issn>1476-1645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkktv1DAUhS0EoqWwZIsssWHRFD-S2GaBNAyvSlOooLC1PI7TeBTbwXZAw__jf-HQUgEbVl7cz-fcc3UAeIjRSU1a8VTtshtOMK-QEOIWOMQ1ayvc1s1tcIgQIpVoKTsA91LaIYQ5wfguOKCYM8JEewh-rFUy8IOZQszP4Dq4rfUq2-DhxWCimvbwm80D3NgppODUCFduGkI20Wrr4Ytj-K46M3nYj_DMXI6zs97Alc_WBW9VNsdQ-Q6eG5-Vs90yPE0FL_plCPsQ4UubknGLqengZ5t0cR3hxtg0OFU0kk2wOCn4cRqNNzoHZ78XdNXNY4bnZdcifh_c6dWYzIPr9wh8ev3qYv222rx_c7pebSpd1zRXXPWUad62pEHaNAJrxrQWou9rzHvKedepLS-H0VhwiphuO8a6WmnRbsuPhh6B51e607x1ptPFumwrp2idinsZlJV_T7wd5GX4KhlCnJK6CDy5Fojhy2xSlm6JPI7KmzAnSShFlAjaLF6P_0F3YY6-xCsUazitEcP_pQghnBequqJ0DClF09-sjJFcaiR_1UhiLpcaFf7Rnzlv6N-9oT8BpaTINw</recordid><startdate>20200201</startdate><enddate>20200201</enddate><creator>Vechi, Hareton Teixeira</creator><creator>Sousa, Ana Solange Vasconcelos de</creator><creator>Cunha, Mirella Alves da</creator><creator>Shaw, Jeffrey Jon</creator><creator>Luz, Kleber Giovanni</creator><general>Institute of Tropical Medicine</general><general>The American Society of Tropical Medicine and Hygiene</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20200201</creationdate><title>Case Report: Combination Therapy with Liposomal Amphotericin B, N-Methyl Meglumine Antimoniate, and Pentamidine Isethionate for Disseminated Visceral Leishmaniasis in a Splenectomized Adult Patient</title><author>Vechi, Hareton Teixeira ; Sousa, Ana Solange Vasconcelos de ; Cunha, Mirella Alves da ; Shaw, Jeffrey Jon ; Luz, Kleber Giovanni</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c443t-8af37c866250ce591c77cc99ff418f388ddab8279c198307c6d77d4ac96b50c53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Amphotericin B - administration & dosage</topic><topic>Amphotericin B - therapeutic use</topic><topic>Antifungal agents</topic><topic>Antiprotozoal Agents - administration & dosage</topic><topic>Antiprotozoal Agents - therapeutic use</topic><topic>Bone Marrow - parasitology</topic><topic>Case reports</topic><topic>Combination therapy</topic><topic>Drug Therapy, Combination</topic><topic>Humans</topic><topic>Immunocompromised Host</topic><topic>Intestinal Mucosa - parasitology</topic><topic>Leishmaniasis, Visceral - drug therapy</topic><topic>Leishmaniasis, Visceral - immunology</topic><topic>Lymph Nodes - parasitology</topic><topic>Male</topic><topic>Meglumine Antimoniate - administration & dosage</topic><topic>Meglumine Antimoniate - therapeutic use</topic><topic>Middle Aged</topic><topic>Parasitic diseases</topic><topic>Pentamidine - administration & dosage</topic><topic>Pentamidine - therapeutic use</topic><topic>Splenectomy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Vechi, Hareton Teixeira</creatorcontrib><creatorcontrib>Sousa, Ana Solange Vasconcelos de</creatorcontrib><creatorcontrib>Cunha, Mirella Alves da</creatorcontrib><creatorcontrib>Shaw, Jeffrey Jon</creatorcontrib><creatorcontrib>Luz, Kleber Giovanni</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The American journal of tropical medicine and hygiene</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Vechi, Hareton Teixeira</au><au>Sousa, Ana Solange Vasconcelos de</au><au>Cunha, Mirella Alves da</au><au>Shaw, Jeffrey Jon</au><au>Luz, Kleber Giovanni</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Case Report: Combination Therapy with Liposomal Amphotericin B, N-Methyl Meglumine Antimoniate, and Pentamidine Isethionate for Disseminated Visceral Leishmaniasis in a Splenectomized Adult Patient</atitle><jtitle>The American journal of tropical medicine and hygiene</jtitle><addtitle>Am J Trop Med Hyg</addtitle><date>2020-02-01</date><risdate>2020</risdate><volume>102</volume><issue>2</issue><spage>268</spage><epage>273</epage><pages>268-273</pages><issn>0002-9637</issn><eissn>1476-1645</eissn><abstract>In immunocompromised patients, visceral leishmaniasis (VL) can present with atypical clinical symptoms that include poor response to treatment. No optimal therapeutic regimen is available for such cases. In a splenectomized male patient, we observed a disseminated form of the disease in the liver, bone marrow, lymph nodes, and gastrointestinal tract. There was an apparent clinical improvement when he was initially treated with liposomal amphotericin B (L-AmB), but this was followed by a relapse involving severe clinical symptoms. He was finally treated successfully with a combination of L-AmB, meglumine antimoniate, and pentamidine isethionate. It is important to include asplenia as an immunosuppressive condition that induces exotic VL pathologies. In such cases, combination anti-
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| subjects | Amphotericin B - administration & dosage Amphotericin B - therapeutic use Antifungal agents Antiprotozoal Agents - administration & dosage Antiprotozoal Agents - therapeutic use Bone Marrow - parasitology Case reports Combination therapy Drug Therapy, Combination Humans Immunocompromised Host Intestinal Mucosa - parasitology Leishmaniasis, Visceral - drug therapy Leishmaniasis, Visceral - immunology Lymph Nodes - parasitology Male Meglumine Antimoniate - administration & dosage Meglumine Antimoniate - therapeutic use Middle Aged Parasitic diseases Pentamidine - administration & dosage Pentamidine - therapeutic use Splenectomy |
| title | Case Report: Combination Therapy with Liposomal Amphotericin B, N-Methyl Meglumine Antimoniate, and Pentamidine Isethionate for Disseminated Visceral Leishmaniasis in a Splenectomized Adult Patient |
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