LIPOSOMAL AMPHOTERICIN B FOR VISCERAL LEISHMANIASIS IN A KIDNEY ALLOGRAFT PATIENT
Marina Valente, Massimo Marroni, Claudio Sfara, Daniela Francisci, Lisa Malincarne, Giampiero Gubbiotti, Massimo Cozzari, Giacinta Tordini, and Giuliano Stagni

OBJECTIVE: To report a case of visceral leishmaniasis treated with liposomal amphotericin B (LAB) after probable failure with amphotericin B lipid complex (ABLC).

CASE SUMMARY: A 62-year-old white renal transplant recipient was admitted for pyrexia, hepato-spleno-megaly, and pancytopenia. Leishmania amastigotes were detected from bone marrow aspirate and in circulating blood monocytes and neutrophils. The patient, who weighed 56 kg, received ABLC at a starting dose of 200 mg/d (3.6 mg/kg of body weight per day) for 13 days, achieving a total dose of 2,600 mg (46 mg/kg) without clinical improvement. The patient was switched to 100 mg/d (1.8 mg/kg) of LAB for 10 days, after which a dose of 250 mg (4.5 mg/kg) was repeated on days 17, 24, 31, and 38. Twenty-four hours after the first dose of LAB, the patient showed an excellent clinical response. On the following days, there was a progressive increase in hemoglobin concentration and leukocyte and platelet counts. Three months later, the patient was asymptomatic.

DISCUSSION: Although treatment with ABLC appears to be effective for the treatment of Indian patients with visceral leishmaniasis, experience with immunocompromised patients is limited. This is the first case of a renal transplant recipient in which ABLC was used to treat visceral leishmaniasis without remarkable efficacy, but with infusion-related adverse effects perhaps due to the use of higher doses.

CONCLUSIONS: A randomized comparative trial is needed to compare LAB with ABLC in the treatment of visceral leishmaniasis in patients who have received kidney allografts.

J Pharm Technol 2002;18:187-90.