Failure of Rifampin Therapy to Cure Cutaneous Leishmaniasis

To the Editor.—  We have read with interest the letters of Griffiths and Sodeify¹ and Vásquez,² in which rifampin is mentioned as a valuable drug for the treatment of cutaneous leishmaniasis. As stated by Selim and Kandil,³ who reported successful results with the use of rifampin in 41 patients with leishmaniasis, "therapeutic measures bear the characteristics of being numerous, short lived, and disappointing after initial enthusiasm." We would like to report two cases in which this statement unfortunately applies to rifampin as well.

Report of Cases.—Case 1.—  A pustule developed on the upper lip of a 19-year-old woman three months after her return from Israel. Later, an ulcer occurred on the upper lip and the right forearm. Three months after this occurrence, a biopsy specimen from the forearm lesion indicated Leishman-Donovan-like bodies. Rifampin therapy (600 mg twice daily for ten days) was started. During the course