Leishmaniasis: A Case History and Treatment Failure With Rifampin

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Abstract
To the Editor.— In two recent letters,1,2 rifampin is mentioned as a potentially useful drug for the treatment of American cutaneous leishmaniasis. This communication reports a case in which rifampin failed to alter the development of this disease. Report of a Case.— The patient, a 33-year-old man, lived in the Canal Zone, Panama, from 1973 until June 1977. In July 1977, the patient noted an erythematous papule on his left palm. His tuberculin skin test, which had been negative in the spring of 1977, was positive in August 1977. Based on the positive skin test, a biopsy specimen was obtained and cultures prepared for acid-fast bacilli and fungi. A clinical diagnosis of cutaneous mycobacteriosis was made. Treatment was started with rifampin, 600 mg twice a day; isoniazid, 300 mg four times a day; and ethambutol hydrochloride, 1,200 mg four times a day. During five weeks of therapy, the lesion

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