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Keratitis occurring in patients treated with miltefosine for post-kala-azar dermal leishmaniasis
  1. Rakhi Kusumesh1,
  2. Anita Ambasta1,
  3. Lalan Kumar Arya1,
  4. Nilesh Mohan1,
  5. Bibhuti Prassan Sinha1,
  6. Vidyanand Ravidas2
  1. 1 Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
  2. 2 Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
  1. Correspondence to Rakhi Kusumesh, Cornea and Ocular Surface Services, Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India; drkrakhi{at}


Aim To describe the characteristic clinical features and management of keratitis in the patients receiving miltefosine for post-kala-azar dermal leishmaniasis (PKDL).

Methods The medical records of five patients with PKDL who presented with keratitis were reviewed retrospectively from April 2018 to December 2019. The evaluation included a thorough medical history including details on drugs used, particularly miltefosine. The drug causality assessment was also performed. The clinical and microbiological characteristics of keratitis were noted.

Results The ocular symptoms included pain, redness, watering, photophobia and diminution of vision. Slit-lamp biomicroscopy revealed peripheral, paralimbal, ring-shaped, full-thickness stromal infiltration resulting in ulcerative keratitis in all cases. Two patients had unilateral keratitis, while three had bilateral keratitis. All five patients received miltefosine for an average period of 48 days before the onset of keratitis. The corrected distance visual acuity at presentation ranged from hand movement to 20/125. The causality assessment revealed a ‘probable’ association between the adverse drug reaction and miltefosine in all patients. Discontinuation of miltefosine and initiation of corticosteroid therapy resulted in resolution of keratitis in all cases. The unilateral keratitis treated with topical corticosteroids had improved outcomes, but poor outcomes were found in the bilateral keratitis.

Conclusion These observations indicate that prolonged use of miltefosine might cause keratitis that resembles infectious keratitis. Early diagnosis with discontinuation of the drug and initiation of corticosteroid therapy are the key to successful management.

  • Miltefosine
  • Post-kala-azar dermal leishmaniasis
  • Ring ulcer
  • Annular ulcer
  • Acanthamoeba keratitis

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  • Contributors Conception and design of the study: RK. Acquisition, analysis and interpretation of data: RK, AA, LKA. Manuscript preparation: RK, AA. Interpretation of laboratory tests: LKA, VR. Manuscript review: BPS, NM, RK, AA.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Written informed consent was obtained from all patients. The study was approved by Institutional Ethics Committee of Indira Gandhi Institute of medical Sciences (1393/IEC/IGIMS/2020).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplemental information.

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