Success in the Treatment of Diffuse Cutaneous Leishmaniasis after Prolonged Use of Miltefosine

Diffuse cutaneous leishmaniasis (DCL) is a rare chronic disease caused by Leishmania (Leishmania) amazonensis in Brazil, which is characterized by anergy of the host cellular immune response and refractory to available treatments. We report the case of a 41-year-old male patient with DCL in Goiânia, Goiás, Brazil with a history of more than 60 drug treatment regimens over 22 years who presented complete disease remission after 180 days of a miltefosine treatment regimen. Disease remission was followed by a considerable increase in proinflammatory cytokines interferon-gamma, tumor necrosis factor, and interleukin-6 in the patient's serum. Twenty-two months after the end of treatment with miltefosine, the patient remained without recurrence of DCL and did not require any additional therapeutic intervention. Long-term treatment with miltefosine, at least for 180 days, may represent an alternative to treat patients with DCL to obtain clinical cure and considerable improvement in the quality of life of patients.