Pathogens (Jun 2023)

The Extraordinary Case of a Woman with a 30-Year-Long Diffuse Leishmaniasis Cured with One Single Ampoule of Intranasal Pentavalent Antimoniate

  • Sheila V. C. B. Gonçalves,
  • Dorcas L. Costa,
  • João da J. Cantinho-Junior,
  • José N. Vieira-Junior,
  • Edna A. Y. Ishikawa,
  • Rubens N. Costa,
  • Antônio C. G. Costa-Filho,
  • Ronald da C. Araújo,
  • Silvia R. B. Uliana,
  • Jenicer K. U. Y. Yasunaka,
  • Adriano C. Coelho,
  • Jackson M. L. Costa,
  • Carlos H. N. Costa

DOI
https://doi.org/10.3390/pathogens12070890
Journal volume & issue
Vol. 12, no. 7
p. 890

Abstract

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Infection with Leishmania amazonensis and L. mexicana may lead to diffuse cutaneous leishmaniasis. The cure is exceptional, especially for the strange case of this lady. Case report: The patient acquired the disease in childhood and remained with lesions for over 30 years, albeit several treatments. She worsened after a pregnancy, developing disseminated lesions. Miltefosine with amphotericin B and pentamidine resulted in remission. Lesions reappeared after one year, accompanied by intra-nasal infiltration of the disease. The nasal spraying of a single ampoule of pentavalent antimoniate resulted in the sustained disappearance of the nasal symptoms and all the cutaneous lesions. After over eight years, she remains disease-free, albeit under renal replacement therapy. The high nasal mucosal antimonial concentration may explain the long-lasting cure via new MHC class I epitope-specific CD8+ cell clones against L. amazonensis present in the nasal mucosa.

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