{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T07:50:18Z","timestamp":1767340218969},"reference-count":11,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2007,4,11]],"date-time":"2007-04-11T00:00:00Z","timestamp":1176249600000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Dermatology"],"published-print":{"date-parts":[[2007,4]]},"abstract":"A 26\u2010year\u2010old man presented to our clinic for advice on treatment options regarding cutaneous leishmaniasis (CL) with multiple lesions. The biopsy revealed Leishmania<\/jats:italic> amastigotes; Leishmania major<\/jats:italic> was identified by polymerase chain reaction (PCR).11 <\/jats:sup>Leishmania<\/jats:italic> serology (indirect immunofluorescence test) was positive at 1\u00a0:\u00a0160 (normal, \u2264\u00a01\u00a0:\u00a040).<\/jats:p>Ten weeks earlier, the patient had spent a 1\u2010week biking holiday in central Tunisia. Two weeks after returning to Germany, he noticed the flaring up of multiple insect bites (>\u00a040) contracted in Tunisia on both arms. The lesions increased in size and axillary lymph node enlargement occurred. Some of the nodular lesions disappeared spontaneously and some increased in size and showed central ulceration. When we first saw the patient, he had six lesions on his right arm and one on his left arm. The largest lesion was on the dorsum of the right hand (Fig.\u00a01<\/jats:ext-link>) and showed an indurated edge and central ulceration. Before starting systemic treatment, the patient decided to wait a few weeks in case spontaneous improvement occurred. However, 8\u00a0weeks later, the ulceration had further increased in size (Fig.\u00a02<\/jats:ext-link>) from a diameter of 2\u00a0cm initially to a diameter of 5\u00a0cm. Regional lymphatic spread with palpable nodules along the adjacent lymphatic vessel had occurred. With the patient's informed consent, treatment with oral miltefosine, according to his body weight of 96\u00a0kg, was started at 50\u00a0mg three times daily for 28\u00a0days. The treatment was well tolerated without any subjective side\u2010effects reported. Liver enzymes, serum creatinine, and urea were monitored during treatment. There was a mild increase in liver enzymes during the third week of treatment: aspartate aminotransferase (AST), 49\u00a0U\/L (normal, <\u00a035\u00a0U\/L); alanine aminotransferase (ALT), 107\u00a0U\/L (normal, <\u00a045\u00a0U\/L); this resolved spontaneously.<\/jats:p>Eight weeks before the start of treatment<\/jats:p><\/jats:caption>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p>At the beginning of treatment with regional lymphatic spread<\/jats:p><\/jats:caption>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p>Ten days after completion of treatment, the rolled edge had disappeared and the central ulcer had almost healed (Fig.\u00a03<\/jats:ext-link>). Figure\u00a04<\/jats:ext-link> shows the lesion 5\u00a0months after completion of treatment.<\/jats:p>Ten days after completion of treatment<\/jats:p><\/jats:caption>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p>Five months after completion of treatment<\/jats:p><\/jats:caption>image<\/jats:alt-text><\/jats:graphic><\/jats:fig><\/jats:p>","DOI":"10.1111\/j.1365-4632.2007.03153.x","type":"journal-article","created":{"date-parts":[[2007,4,28]],"date-time":"2007-04-28T15:49:09Z","timestamp":1177775349000},"page":"385-387","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["First case of typical Old World cutaneous leishmaniasis treated with miltefosine"],"prefix":"10.1111","volume":"46","author":[{"given":"Marija","family":"Stojkovic","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Junghanss","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Krause","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert N.","family":"Davidson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2007,4,11]]},"reference":[{"key":"e_1_2_2_2_2","first-page":"1237","article-title":"Heterogeneity of cutaneous leishmaniasis with emphasis on the Old World","volume":"123","author":"Peters W","year":"1993","journal-title":"Schweiz Med Wochenschrift"},{"key":"e_1_2_2_3_2","doi-asserted-by":"publisher","DOI":"10.2165\/00003495-199856060-00005"},{"key":"e_1_2_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00001432-200310000-00005"},{"key":"e_1_2_2_5_2","doi-asserted-by":"publisher","DOI":"10.1086\/428736"},{"key":"e_1_2_2_6_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa021556"},{"key":"e_1_2_2_7_2","doi-asserted-by":"publisher","DOI":"10.1086\/380638"},{"key":"e_1_2_2_8_2","doi-asserted-by":"publisher","DOI":"10.1086\/383321"},{"key":"e_1_2_2_9_2","volume-title":"Fachinformation Miltefosine. 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