Immune response following miltefosine therapy in a patient with post-kala-azar dermal leishmaniasis.

We report a case of post-kala-azar dermal leishmaniasis in which real-time PCR was exploited to measure changes in cytokine transcripts in lesion tissue before and after oral miltefosine treatment. Unlike antimonial therapy elevated levels of IFNgamma transcripts were noted, whereas TNFalpha, IL-10 and transforming growth factor-beta declined similar to that observed after therapy with antimonials. A significant increase in IFNgamma and CD40 levels seen after miltefosine therapy could enhance parasite clearance. The patient remained normal after 18 months of follow-up.