title: A rare case of Visceral leishmaniasis with multiple relapse and multi-drug unresponsive: successfully treated with combination therapy.
abstract: METHODS
  We report a 32-year old relapse case of Visceral leishmaniasis, treated with Paromomycin who belonged from a endemic zone of Bihar state, India. After confirmation, he was treated with Amphotericin B, followed by Liposomal Amphotericin B in full course and even in higher dose. But after each therapy, the patient either did not responded or relapsed after treatment. Ultimately, the patient was successfully treated with combination therapy of Liposomal amphotericin B and Miltefosine without any relapse.
  
  
  CONCLUSIONS
  The multi-drug unresponsive Visceral leishmaniasis cases could pose a major threat to treatment strategy in the elimination program. In such situation, combination therapy seems to be a better approach that needs to be explored.
authors.affiliation: Division of Clinical Medicine, RMRIMS (ICMR), Agamkuan, Patna, Bihar, 800 007, India. drnawinkumar@gmail.com
authors.forename: Nawin
authors.initials: N
authors.lastname: Kumar
authors.forename: Prabhat Kumar
authors.initials: PK
authors.lastname: Sinha
authors.forename: Krishna
authors.initials: K
authors.lastname: Pandey
authors.forename: Neena
authors.initials: N
authors.lastname: Verma
authors.forename: Chandra Shekhar
authors.initials: CS
authors.lastname: Lal
authors.forename: Alok
authors.initials: A
authors.lastname: Ranjan
authors.forename: Rakesh Bihari
authors.initials: RB
authors.lastname: Verma
authors.forename: Pradeep
authors.initials: P
authors.lastname: Das
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D018432:Drug Resistance, Multiple / Q000187:drug effects*; D004359:Drug Therapy, Combination / Q000379:methods*; D006801:Humans; D007898:Leishmaniasis, Visceral / Q000188:drug therapy*; D008297:Male; D010767:Phosphorylcholine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012008:Recurrence
chemical_list: D000981:Antiprotozoal Agents; C068538:liposomal amphotericin B; D010767:Phosphorylcholine; C039128:miltefosine; D000666:Amphotericin B