Intravenous Liposomal Amphotericin B for Complicated Pediatric Cutaneous Leishmaniasis: A Case Series

Background: First-line treatments for cutaneous leishmaniasis (CL), including topical agents, are often limited in cases of complicated disease involving multiple, facial, or treatment-resistant lesions. Data on intravenous liposomal amphotericin B (L-AmB) are scarce, especially in children. We report our experience using L-AmB to treat pediatric CL, focusing on treatment rationale, safety, and clinical effectiveness. Methods: A retrospective case series. Diagnosis was confirmed by PCR. Data on demographics, clinical presentation, treatment rationale, adverse events, lab findings, and outcomes, during treatment and follow-up, were collected. Results: Twenty-seven children were included, most (96%) with Leishmania major. The mean number of lesions per child was 5.71 ± 6.19. All had facial involvement; 41% nasal and 15% eyelid. Most lesions were ulcerated (78%). Prior treatment failure was common (78%), with the use of topical antimicrobials, liposomal amphotericin gel, and paromomycin-containing ointments (59%, 38%, 19%, respectively). Twenty-four children (89%) completed treatment successfully. Adverse events occurred in 41% of cases but were mostly mild and reversible: flushing, rash, shortness of breath, and vomiting (11%, each). One case of transient renal impairment and one case with neutropenia were recorded. Early improvement was noted by day 10, with 50% (n = 12) of cases exhibiting crust falling/reduced ulceration and a 50% lesion size reduction. By day 30–90, 92% achieved substantial healing without the need for further therapy. Nevertheless, scarring was noted in 79% of cases. Conclusions: L-AmB treatment appears to be safe and effective for pediatric CL, particularly in cases with facial lesions or prior treatment failure. Clinical improvement was notable, although scarring was common.