title: [Liposomal Amphotericin B for treatment of acute phase and secondary prophylaxis of visceral leishmaniasis in a HIV positive patient]
abstract: The authors describe a clinical case of an HIV+, HBV+ and HCV+ 46-year-old male patient, with a history of drug abuse of intravenous heroin, admitted to their attention for high remittent fever (39 C), weight loss and severe dysphonia. The increasing severity of dysphonia had required a fiberlaryngoscopic examination which allowed a diagnosis of hypertrophy of vocal chords. The Wright-Giemsa stain performed on vocal chord biopsy evidenced Leishmania infantum. The same protozoon was subsequently also revealed in bone marrow aspirate. The patient underwent a course of therapy with Amphotericin B deoxycolate (0.5 mg/kg) which had to be interrupted due to insurgence of diffuse petechiae and switched to Amphotericin in cholesterinic suspension (2.5 mg/kg every 21 days). After three months, insurgence of high fever related to the infusion induced the start of therapy with liposomal Amphotericin B (3 mg/kg every 28 days) which led in 4 weeks to a complete clinical remission. Prophylaxis with liposomal Amphotericin B is continuing and remission has persisted for 40 months. This case report shows the importance of liposomal Amphotericin B therapy in order either to obtain clinical remission of visceral leishmaniasis or, in secondary prophylaxis, to reduce the risk of the disease's recurrence.
authors.affiliation: Dipartimento di Medicina Interna, Divisione di Medicina Interna ad Orientamento Immunologico e Dipartimento di Medicina Legale, Universita di Genova, Genova, Italia.
authors.forename: G.
authors.initials: G
authors.lastname: Murdaca
authors.forename: M.
authors.initials: M
authors.lastname: Setti
authors.forename: A.
authors.initials: A
authors.lastname: Campelli
authors.forename: M.
authors.initials: M
authors.lastname: Ghio
authors.forename: F.
authors.initials: F
authors.lastname: Puppo
authors.forename: F.
authors.initials: F
authors.lastname: Indiveri
vernacular_title: L'utilizzo dell'Amfotericina B liposomiale nel trattemento della fase acuta e nela profilassi secondaria della Leishmaniosi viscerale in un paziente HIV positivo.