RT Journal Article SR Electronic T1 Meglumine antimoniate combination treatment for relapsing Kala-azar after treatment and secondary prophylaxis failure with liposomal amphotericin B in two HIV-coinfected patients JF BMJ Case Reports JO BMJ Case Reports FD BMJ Publishing Group Ltd SP e231929 DO 10.1136/bcr-2019-231929 VO 12 IS 12 A1 Lara Camara A1 João Queirós A1 Rita Ribeiro A1 Eugénio Teófilo YR 2019 UL http://casereports.bmj.com/content/12/12/e231929.abstract AB 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.