Successful Treatment of Cutaneous Leishmania infantum Infection with Immunocryosurgery after Failure of the Respective Monotherapies.

Herein, we present a case of cutaneous leishmaniasis successfully treated with a modified immunocryosurgery protocol. A 46-year-old male Caucasian presented with two nodules on the forehead of eight-month duration. He reported an unsuccessful attempt to treat the lesions with a session of cryosurgery elsewhere. During the clinical examination, two adjacent hard mobile nodules that did not infiltrate the underlying tissues were notable. Their diameter was 10 mm and 15 mm, respectively. There were no clinical, laboratory or imaging data in favor of a systemic infection. Histology and polymerase chain reaction (PCR) of the tissue confirmed a Leishmania infantum cutaneous leishmaniasis. Therapy with application of 5% imiquimod cream three times per week was initiated. After seven weeks of treatment and despite the substantial local inflammatory reaction, there was no evidence of clinical resolution of the lesions. Treatment was paused and five weeks later the two nodules had merged into a single lesion measuring 40x25 mm. Treatment with three times per week topical imiquimod was reinstated with scheduled cryosurgery sessions, within the context of a modified immunocryosurgery protocol, i.e., cryosurgery sessions during continuous imiquimod application. The patient was treated for a total period of nine weeks. The treatment comprised topical imiquimod and two cryosurgery sessions (open spray liquid nitrogen, two cycles, 15 seconds each) at weeks 3 and 6. At the end of treatment there was complete clinical remission of the lesion leaving an atrophic scar that significantly improved during follow-up. The patient remained disease free for 24 months. The applied modification of the standard immunocryosurgery protocol (three times per week imiquimod application, multiple cryosurgery sessions) achieved treatment of a L. infantum cutaneous leishmaniasis that was refractory to the respective monotherapies.