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Case report
Meglumine antimoniate combination treatment for relapsing Kala-azar after treatment and secondary prophylaxis failure with liposomal amphotericin B in two HIV-coinfected patients
  1. Lara Camara,
  2. João Queirós,
  3. Rita Ribeiro and
  4. Eugénio Teófilo
  1. Serviço de Medicina 2.3, Hospital Santo António dos Capuchos, Lisboa, Portugal
  1. Correspondence to Dr João Queirós; jp.queiros92{at}


Visceral leishmaniasis (VL) is a protozoan infection caused by Leishmania infantum and L. donovani with a higher incidence and severity in HIV-infected patients due to its synergistic effect on hampering the immune response, often leading to death after treatment failure. Literature regarding the management of relapsing VL in HIV-coinfected patients is lacking. Many experts recommend a combined therapy with liposomal amphotericin B and miltefosine. The use of pentavalent antimonials is often discouraged due to their toxicity. We report two cases of successful response to treatment with combined therapy with meglumine antimoniate followed by secondary prophylaxis with miltefosine and atovaquone on relapsing VL in two HIV-coinfected patients despite treatment and monthly prophylaxis with appropriate doses of liposomal amphotericin B.

  • infectious diseases
  • HIV / AIDS
  • tropical medicine (infectious disease)
  • drugs: infectious diseases

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  • Contributors All the authors work in the same department of the same hospital. The idea for the article came up when JQ and RR were discussing how to treat patient 1 who was in our care at that time with ET, who had previous experience with a patient with relapsing leishmaniasis whom he decided to treat with pentavalent antimonials (patient 2). After we observed a positive outcome to treatment, LC, who was familiar with both patients, proposed we write a case report about it. The data from patient 1 was collected by me and from patient 2 by LC. After that, the four authors met several times and RR and ET proposed we should focus our report on the fact that pentavalent antimonials were discouraged but ended up being our best option. At that time, all four authors did their individual bibliographic research on the subject and reunited again, discussing which articles were more relevant for the article. Then LC and JQ wrote a draft of the paper which would be then revised and corrected by ET and by RR. The final version was then approved by all authors and finally submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.