title: AMERICAN CUTANEOUS LEISHMANIASIS WITH UNUSUAL CLINICAL PRESENTATION AND RESPONSE TO TREATMENT.
abstract: The clinical manifestations and prognosis of cutaneous leishmaniasis (CL) can be influenced by the immune response of the patient and the species of the parasite. A case of atypical clinical presentation of CL, with development of non-characteristic lesions, poor response to therapy, and a long time to resolution is reported. Confirmatory laboratory tests included parasite detection, indirect immunofluorescence, Montenegro skin test, polymerase chain reaction, and parasite identification by multilocus enzyme electrophoresis. The parasite was identified as Leishmania braziliensis. The lesion was unresponsive to three complete courses of N-methylglucamine antimoniate intramuscular, and to treatment with pentamidine. The patient did not tolerate amphotericin B. The lesion finally receded after treatment with intravenous N-methylglucamine antimoniate. It is essential to ensure the accuracy of diagnosis and the appropriate treatment, which can include the use a second choice drug or a different route of administration.
authors.affiliation: Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Maringá, Maringá, Paraná, Brasil, acbsfernandes@gmail.com, raissap@gmail.com.
authors.forename: Andrea Claudia Bekner Silva
authors.initials: AC
authors.lastname: Fernandes
authors.affiliation: Programa de Pós-Graduação em Ciências da Saúde, Universidade Estadual de Maringá, Maringá, Paraná, Brasil, acbsfernandes@gmail.com, raissap@gmail.com.
authors.forename: Raíssa Bocchi
authors.initials: RB
authors.lastname: Pedroso
authors.affiliation: Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, Paraná, Brasil, easvenazzi@uem.br, pdzanzarini@uem.br, smaaristides@uem.br, mvclonardoni@uem.br, tgvsilveira@uem.br.
authors.forename: Eneide Aparecida Sabaini
authors.initials: EA
authors.lastname: Venazzi
authors.affiliation: Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, Paraná, Brasil, easvenazzi@uem.br, pdzanzarini@uem.br, smaaristides@uem.br, mvclonardoni@uem.br, tgvsilveira@uem.br.
authors.forename: Paulo Donizeti
authors.initials: PD
authors.lastname: Zanzarini
authors.affiliation: Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, Paraná, Brasil, easvenazzi@uem.br, pdzanzarini@uem.br, smaaristides@uem.br, mvclonardoni@uem.br, tgvsilveira@uem.br.
authors.forename: Sandra Mara Alessi
authors.initials: SM
authors.lastname: Aristides
authors.affiliation: Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, Paraná, Brasil, easvenazzi@uem.br, pdzanzarini@uem.br, smaaristides@uem.br, mvclonardoni@uem.br, tgvsilveira@uem.br.
authors.forename: Maria Valdrinez Campana
authors.initials: MV
authors.lastname: Lonardoni
authors.affiliation: Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Maringá, Paraná, Brasil, easvenazzi@uem.br, pdzanzarini@uem.br, smaaristides@uem.br, mvclonardoni@uem.br, tgvsilveira@uem.br.
authors.forename: Thaís Gomes Verzignassi
authors.initials: TG
authors.lastname: Silveira
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use*; D006801:Humans; D007892:Leishmania braziliensis; D016773:Leishmaniasis, Cutaneous / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008536:Meglumine / Q000627:therapeutic use*; D000077485:Meglumine Antimoniate; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D009942:Organometallic Compounds; D008536:Meglumine; D000077485:Meglumine Antimoniate; D000666:Amphotericin B