368. Successful treatment of resistant visceral leishmania with repeated trial of Liposomal Amphotericin B- A Case Report

Abstract Background Although visceral leishmaniasis is endemic in various parts of India, management still a challenge due to multiple drug resistance. Here we describe case 50 years old female who was diagnosed with at tertiary care hospital northern India and managed repeated trial liposomal Amphotericin B. Methods Case Discussion: The patient presented the outpatient department recurrent fever, mild intermittent abdominal discomfort associated generalized weakness for past one month. On per abdomen examination had splenomegaly spleen palpable 8 cm below left costal margin. Blood investigations were suggestive pancytopenia (leukocyte 1800/cumm, Hemoglobin 7 g/dl, Platelet count: 80,000/cumm) along severe neutropenia (Absolute neutrophil 400/cumm) . CT showed massive (23 cm) hepatomegaly Leishmania Immunoglobulin G positive. Bone marrow biopsy revealed hyperproliferative plasmacytosis (12-15%). Leishman-Donovan bodies negative. Serum immunofixation negative M spike serum light chain assay also She B (3mg/kg) days subsequently discharged. After 3 months, again continuous lethargy, running nose, palpitations. Her blood work-up again. tested anti- rk39 antibody, which given repeat Liposomal different regimen-3 mg/kg dose on Day 1 5, followed by 6th 14, 7th 21, as FDA approved regimen. Patient recovered well. most recent total leukocyte counts eventually improved 4800 normal differential count. Platelets increased 180,000, around 10.8g/dl non physical examination. Results Treatment leishmania can become complicated resistance drugs especially when single agent being given. Conclusion But resource limited countries regimens amphotericin be tried might helpful speedy clinical recovery cost effectiveness. Disclosures All Authors: No reported disclosures.