In contrast to ML in the Americas, cases of Old World ML may not typically be preceded or accompanied by a cutaneous lesion and show a higher intralesional

parasite burden. Cases of primary ML are rare, but may occur in both immunocompetent and immunosuppressed see more patients. While the nasal cavity is affected in more than 90% of New World ML cases, the larynx and oral mucosa are more frequently involved in Mediterranean ML. Concerning clinical outcome, cases of primary ML in the Mediterranean region show a better prognosis than South American cases. Cases of primary ML due to L infantum are, even though rare, regularly reported from Southern Europe and should therefore be included in the differential diagnosis of any patient—immunocompetent or not—who presents with chronic mucosal lesions and has traveled to or resides in endemic areas. Pentavalent antimonials (meglumine antimoniate and sodium stibogluconate) have been used for decades and are still the gold

standard for treatment of New World Leishmania species and for patients with severe Old World leishmaniasis.4 Common side effects of antimonial treatment include nausea, abdominal complaints (pancreatitis), myalgia, arthralgia, skin rash, and laboratory abnormalities such as abnormal liver function tests and elevated serum amylase levels.5 In rare cases, meglumine selleck chemical antimoniate Meloxicam may induce a “drug reaction with eosinophilia and systemic symptoms” (DRESS), representing a drug hypersensitivity reaction.6 Concerning the skin manifestations of our patient, there were no accompanying clinical signs or laboratory finding [especially no hypereosinophilia (Eosinophiles ≤4%)] pointing to a meglumine-induced DRESS syndrome. Reversible ECG alterations are seen in 30% to 60% of cases and may occur without evidence of myocardial damage.7,8 Severe cardiotoxic side effects, including prolongation of the QTc interval9 and torsade de pointes tachycardia,10 have been observed with use of

pentavalent antimonials. Our case presentation highlights the potential risk of developing severe hypokalemia during pentavalent antimonial treatment, which has so far only been reported in two cases.11,12 This rare but potentially fatal event is particularly important since most ML patients are treated as out-patients and therefore subject to limited clinical and laboratory check-ups. Miltefosine features the advantage of oral administration and has proven efficacy in the treatment of visceral leishmaniasis and New World CL and ML. Concerning the treatment of Old World CL13–15 and ML16,17 with miltefosine, data are still scarce and do not—despite promising reports—allow for general judgement. Common side effects of miltefosine treatment include nausea, vertigo, vomiting, and diarrhea. Abnormal liver and kidney function tests are observed in 10% of the cases.