Corneal complications following Post Kala-azar Dermal Leishmaniasis treatment

Post Kala-azar Dermal Leishmaniasis (PKDL) is a sequel of Visceral Leishmaniasis (VL). The patients act as a reservoir for the causative parasite (i.e. Leishmania donovani) and thus should be diagnosed and treated with the utmost urgency to prevent the transmission of the disease. In this study, we tried to report the first instances of corneal complications supposedly associated with Miltefosine (MF), in PKDL patients and the probable pathophysiology of such events. The recently rejuvenated National Kala-azar Elimination Program in Bangladesh has put great emphasis on monitoring all the leishmaniasis patients to investigate possible adverse drug reactions (ADR). A total of 194 patients have received Miltefosine for the treatment of Post Kala-azar Dermal Leishmaniasis. So far five patients were found to have developed unilateral ophthalmic complications during the periods from May 2016 to October 2017, after being treated with MF for PKDL. Unfortunately, one of whom had to go through complete evisceration of the affected eyeball. Despite the fact that MF is the only oral formulation of choice to treat PKDL, occurrences of such unexpected ADRs after MF administration urges the exploration of the pathogenesis of such incidents and determine measures to avert such occurrences from happening in future.Author summary: PKDL is a sequel of VL, which acts as a source of leishmaniasis and should be diagnosed and treated at the earliest possible time to prevent disease transmission. In Bangladesh during the period from May 2016 to October 2017, a total of 5 patients were diagnosed to have Miltefosine induced unilateral ophthalmic complications. Miltefosine was introduced as an anti-parasitic drug through drug repurposing, and it has a complex mechanism of acting towards the parasite killing. The mechanism itself in certain circumstances may produce ophthalmic complications by its metabolites or by causing dry eye disease. Miltefosine is the only oral drug for leishmaniasis. Hence the etiopathogenesis and prevention strategy of such severe adverse events must be explored.