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Nephrol Dial Transplant (1999) 14: 2941-2943
© 1999 European Renal Association-European Dialysis and Transplant Association

Case Report

The renal transplant patient with visceral leishmaniasis who could not tolerate meglumine antimoniate—cure with ketoconazole and allopurinol

Migue Hueso1, Jordi Bover1, Daniel Serón1, Salvador Gil-vernet1, Gabriel Rufí2, Jeroni Alsina1 and Josep M. Grinyó1

1 Departments of Nephrology and 2 Infectious Diseases, Ciutat Sanitària i Universitària de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain

Correspondence and offprint requests to: Josep M. Grinyó MD, Department of Nephrology, Hospital de Bellvitge, C. Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain.

Keywords: acute pancreatitis; allopurinol; leishmaniasis; ketoconazole; pentavalent antimonial drugs; renal transplantation



   Introduction
 
Visceral leishmaniasis is an endemic parasitic infection in the Mediterranean area [1]. Shortly after the initial infection, the parasite spreads through the monocyte macrophage system and a granulomatous cellular immune response develops, leaving the parasite in a latent form. Therefore, hosts may remain free of clinical symptoms for long periods of time. Although impairment of cellular immunity could trigger overt disease, visceral leishmaniasis is uncommon in allograft recipients, even in endemic areas. However, immunocompromised hosts have a worse outcome since the disease behaves more aggressively. These individuals have an atypical clinical presentation and course of disease, which may delay the diagnosis, and they respond more poorly to therapy [2,3].

Pentavalent antimonial drugs have been classically considered the therapy of choice, but the frequency of serious adverse events and the increasing incidence of primary parasitic resistance or relapses have stressed the need for alternative treatments. . . . [Full Text of this Article]



   Case
 


   Discussion
 


   Acknowledgments
 


   References
 

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