Cure of antimony-unresponsive Indian post-kala-azar dermal leishmaniasis with oral miltefosine

We report the case of a patient with Indian post-kala-azar dermal leishmaniasis (PKDL) who failed to show any response to 2 months' treatment with sodium stibogluconate. Six months later he was treated with oral miltefosine on a compassionate basis as an off-label indication. Miltefosine was given 100 mg daily in divided doses for an initial 8 weeks. Due to insufficient response, the treatment was extended up to a total of 12 weeks. The patient showed an excellent response to treatment, and after 12 months of follow-up there was complete heating of at[ cutaneous lesions. Oral miltefosine appears to be an important alternative for the treatment of PKDL in India and confirmatory studies in controlled clinical trials are needed. (C) 2005 Published by Elsevier Ltd on behalf of Royal Society of Tropical Medicine and Hygiene.