Efficacy of imiquimod 5% cream as first-line management in cutaneous leishmaniasis caused by <i>Leishmania mexicana</i>

Cutaneous leishmaniasis (CL) involves several differential diagnoses as it lacks a gold standard diagnostic test. Its diagnosis is easier in endemic regions; however, many cases come from travelers to endemic areas. A 22-year-old patient, who had recently visited Oaxaca, Mexico, developed two asymptomatic ulcers weeks later on the left auricle and the nose. Leishmania mexicana was identified using polymerase chain reaction. The patient was treated with imiquimod 5% cream three times/week, providing favorable results after 12 weeks, without relapse 2 months after therapy. To our knowledge, this is the first case of CL due to L. mexicana effectively treated with imiquimod.

Keywords:
Leishmaniasis; Imiquimod; Treatment

Authorship

Gabriela Fuentes-Nava

Hospital General de México, Servicio de Dermatología, México.Hospital General de MéxicoMéxicoMéxicoHospital General de México, Servicio de Dermatología, México.

Andrés Tirado-Sánchez

Hospital General de México, Servicio de Dermatología, México.Hospital General de MéxicoMéxicoMéxicoHospital General de México, Servicio de Dermatología, México.

Instituto Mexicano del Seguro Social, Hospital General de Zona 29, Departamento de Medicina Interna, México.Instituto Mexicano del Seguro SocialMéxicoMéxico Instituto Mexicano del Seguro Social, Hospital General de Zona 29, Departamento de Medicina Interna, México.

http://orcid.org/0000-0001-9306-1619

Edith A. Fernández-Figueroa

Instituto Nacional de Medicina Genómica, Laboratorio de Genómica Computacional, México.Instituto Nacional de Medicina GenómicaMéxicoMéxico Instituto Nacional de Medicina Genómica, Laboratorio de Genómica Computacional, México.

Universidad Nacional Autónoma de México, Facultad de Medicina, Centro de Medicina Tropical, Unidad de Medicina Experimental, México.Universidad Nacional Autónoma de MéxicoMéxicoMéxico Universidad Nacional Autónoma de México, Facultad de Medicina, Centro de Medicina Tropical, Unidad de Medicina Experimental, México.

Sokani Sánchez-Montes

Universidad Veracruzana, Facultad de Ciencias Biológicas y Agropecuarias, México.Universidad VeracruzanaMéxicoMéxico Universidad Veracruzana, Facultad de Ciencias Biológicas y Agropecuarias, México.

Ingeborg Becker

Alexandro Bonifaz

Hospital General de México, Servicio de Dermatología, México.Hospital General de MéxicoMéxicoMéxicoHospital General de México, Servicio de Dermatología, México.

Corresponding autor: Dr. Andrés Tirado-Sánchez. e-mail:atsdermahgm@gmail.com

Authors’ contributions: GFN contributed with patient clinical care, data collection, literature search and writing; ATS contributed with data collection, literature search and writing; EFF contributed with data collection and laboratory test; SSM contributed with laboratorial test and data interpretation; IB contributed with data interpretation and writing; and AB contributed with patient clinical care, data collection, data interpretation and writing.

Conflict of Interest: The authors declare that there is no conflict of interest.

SCIMAGO INSTITUTIONS RANKINGS

Hospital General de México, Servicio de Dermatología, México.Hospital General de MéxicoMéxicoMéxicoHospital General de México, Servicio de Dermatología, México.

Figures

Figures (3)

Thumbnail

FIGURE 1:
(A) a 13 × 18 mm ulcerated nodule in the dorsum of the nose; (B) Two weeks of treatment with imiquimod 5% cream; (C) Four weeks of treatment; (D) Eight weeks of treatment; (E) Twelve weeks of treatment; (F) Two months after termination of treatment.

Thumbnail

FIGURE 2:
(A) an ulcerated nodule in the left atrial pavilion; (B) Two weeks of treatment with imiquimod 5% cream; (C) Four weeks of treatment; (D) Eight weeks of treatment; (E) Twelve weeks of treatment; (F) Two months after termination of treatment.

Thumbnail

FIGURE 3:
DNA extraction was done using the High Pure PCR Template Preparation Kit (Roche, Cat.11796828001). The DNA integrity of the clinical sample was evaluated with human glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and it was amplified by qPCR. As positive controls, DNA isolated from Leishmania amazonensis MHOM/BR/00/LTB0016, L. amazonensis IFLA/BR/67/PH8, L. mexicana MHOM/MX/2011/Lacandona, and L. mexicana isolate 14 were used as templates. The sample was positive for L. mexicana. Labels: 1.Molecular size marker; 2.Patient’s DNA; 3.Amplified patient´s DNA; 4.Positive control (Leishmania DNA); and, 5.Negative control (water).

FIGURE 1: (A) a 13 × 18 mm ulcerated nodule in the dorsum of the nose; (B) Two weeks of treatment with imiquimod 5% cream; (C) Four weeks of treatment; (D) Eight weeks of treatment; (E) Twelve weeks of treatment; (F) Two months after termination of treatment.

FIGURE 2: (A) an ulcerated nodule in the left atrial pavilion; (B) Two weeks of treatment with imiquimod 5% cream; (C) Four weeks of treatment; (D) Eight weeks of treatment; (E) Twelve weeks of treatment; (F) Two months after termination of treatment.

FIGURE 3: DNA extraction was done using the High Pure PCR Template Preparation Kit (Roche, Cat.11796828001). The DNA integrity of the clinical sample was evaluated with human glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and it was amplified by qPCR. As positive controls, DNA isolated from Leishmania amazonensis MHOM/BR/00/LTB0016, L. amazonensis IFLA/BR/67/PH8, L. mexicana MHOM/MX/2011/Lacandona, and L. mexicana isolate 14 were used as templates. The sample was positive for L. mexicana. Labels: 1.Molecular size marker; 2.Patient’s DNA; 3.Amplified patient´s DNA; 4.Positive control (Leishmania DNA); and, 5.Negative control (water).

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Efficacy of imiquimod 5% cream as first-line management in cutaneous leishmaniasis caused by <i>Leishmania mexicana</i>

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[1] Corresponding autor: Dr. Andrés Tirado-Sánchez. e-mail:atsdermahgm@gmail.com