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Morsing NV, Andreasen CM, Rasmussen TA, Moll LT. Cutaneous leishmaniasis in a patient with psoriatic arthritis treated with tumour necrosis factor-α inhibitor. Scand J Rheumatol 2024; 53:158-159. [PMID: 38275137 DOI: 10.1080/03009742.2023.2295627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 12/13/2023] [Indexed: 01/27/2024]
Affiliation(s)
- N V Morsing
- Department of Internal Medicine, Regional Hospital Gødstrup, Herning, Denmark
| | - C M Andreasen
- Department of Internal Medicine, Regional Hospital Gødstrup, Herning, Denmark
| | - T A Rasmussen
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - L T Moll
- Department of Internal Medicine, Regional Hospital Gødstrup, Herning, Denmark
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2
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Palacios-Diaz RD, Sahuquillo-Torralba A, Rocamora-Durán V, Unamuno-Bustos BD, Salavert-Lleti M, Santos-Alarcón S, Quintero A, Garcías-Ladaria J, Vila-Payeras A, Martínez-Doménech A, Mateu-Puchades A, Nadal-Lladó C, Botella-Estrada R. Klinisch-pathologische Eigenschaften kutaner und mukokutaner Leishmaniose bei mit TNF-α-Inhibitoren behandelten Patienten. J Dtsch Dermatol Ges 2023; 21:473-481. [PMID: 37183744 DOI: 10.1111/ddg.15007_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 01/03/2023] [Indexed: 05/16/2023]
Affiliation(s)
| | | | | | | | - Miguel Salavert-Lleti
- Infectious Diseases Department, Hospital Universitario y Politécnico La Fe, Valencia, Spanien
| | | | - Adriana Quintero
- Pathology Department, Hospital de Manacor, Illes Baleares, Spanien
| | - Joan Garcías-Ladaria
- Dermatology Department, Hospital Universitario Son Espases, Illes Baleares, Spanien
| | - Aina Vila-Payeras
- Dermatology Department, Hospital Universitario Son Llàtzer, Palma de Mallorca, Illes Baleares, Spanien
| | | | | | - Cristina Nadal-Lladó
- Dermatology Department, Hospital Universitario Son Llàtzer, Palma de Mallorca, Illes Baleares, Spanien
| | - Rafael Botella-Estrada
- Dermatology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spanien
- Department of Medicine, Universitat de València, Valencia, Spanien
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3
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Yadav P, Azam M, Ramesh V, Singh R. Unusual Observations in Leishmaniasis-An Overview. Pathogens 2023; 12:pathogens12020297. [PMID: 36839569 PMCID: PMC9964612 DOI: 10.3390/pathogens12020297] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/06/2023] [Accepted: 01/19/2023] [Indexed: 02/15/2023] Open
Abstract
Leishmaniasis significantly affects the population of the tropics and subtropics. Clinical features and infective species of Leishmania are the primary factors driving the direction of diagnosis. The rise in incidences of atypical presentations present a challenge in patient treatment. Knowledge of unusual/rare presentations can aid in having a broader perspective for including the different aspects during the examination and thus avoid misdiagnosis. A comprehensive literature survey was performed to present the array of atypical presentations confounding clinicians which have been seen in leishmaniasis. Case reports of unusual findings based on the localizations and morphology of lesions and infective species and the predominant geographical sites over almost five decades highlight such presentations in the population. Information regarding the clinical features recorded in the patient and the chosen treatment was extracted to put forward the preferred drug regimen in such cases. This comprehensive review presents various unusual observations seen in visceral leishmaniasis, post-kala-azar dermal leishmaniasis, cutaneous leishmaniasis, and mucocutaneous leishmaniasis. It highlights the need to consider such features in association with differential diagnosis to facilitate proper treatment of the patient.
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Affiliation(s)
- Priya Yadav
- ICMR-National Institute of Pathology, New Delhi 110029, India
- Manipal Academy of Higher Education, Manipal 576104, India
| | - Mudsser Azam
- ICMR-National Institute of Pathology, New Delhi 110029, India
| | - V Ramesh
- Department of Dermatology, ESIC Hospital, Faridabad 1210026, India
| | - Ruchi Singh
- ICMR-National Institute of Pathology, New Delhi 110029, India
- Correspondence: or
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Bahrami S, Oryan A, Bemani E. Anti-leishmanial, immunomodulatory and anti-oxidative activity of quercetin against cutaneous leishmaniasis caused by Leishmania major. Asian Pac J Trop Biomed 2023. [DOI: 10.4103/2221-1691.367689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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5
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Heinemann M, Omansen TF, Hennigs A, Völker K, Menz A, Addo MM, Schmiedel S. Relapsing cutaneous leishmaniasis in a patient requiring TNF-α-inhibitor Infliximab for Takayasu-arteritis: Case report and review of the literature. Travel Med Infect Dis 2020; 37:101700. [PMID: 32339673 DOI: 10.1016/j.tmaid.2020.101700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 04/23/2020] [Indexed: 12/14/2022]
Abstract
Leishmaniasis is a protozoan parasitic infection that can manifest as visceral or cutaneous disease. Immunosuppression, mainly through TNF-α) inhibition, is a risk factor for complicated leishmaniasis that is becoming increasingly known. Here, we present a case of cutaneous leishmaniasis (CL) in a patient who suffers from advanced Takayasu-Arteritis, requiring TNF-α inhibition with infliximab. The primary CL lesions in this 47-year-old, female patient were caused by Leishmaniapanamensis and occurred after a touristic trip to Panama on her right foot. The lesions first resolved under treatment with liposomal amphotericin B. However, ten months later, the patient returned with relapsing lesions requiring further treatment. We discuss the challenges and risks of leishmaniasis in patients with TNF-α inhibition and the rare phenomenon of relapsing CL and the management hereof. We review published cases of CL associated with TNF-α inhibition. A growing body of evidence now suggests that especially CL (and visceral leishmaniasis (VL)) can be associated with TNF-α inhibition. The host response to leishmaniasis is of the Th1-type and TNF-α and interferon-gamma expression are crucial for disease control. Inversely, TNF-α inhibition can lead to complicated and relapsing progression of leishmanial infection. Therefore, we propose that CL and VL should be considered in at-risk patients receiving immunosuppressants.
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Affiliation(s)
- Melina Heinemann
- I. Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till F Omansen
- Bernhard Nocht Institute for Tropical Medicine & I. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Annette Hennigs
- I. Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Völker
- Department of Tropical Medicine at the Bernhard Nocht Institute, German Armed Forces Hospital of Hamburg, Hamburg, Germany
| | - Anne Menz
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marylyn M Addo
- I. Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Schmiedel
- I. Department of Medicine, Division of Infectious Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Bosch-Nicolau P, Ubals M, Salvador F, Sánchez-Montalvá A, Aparicio G, Erra A, Martinez de Salazar P, Sulleiro E, Molina I. Leishmaniasis and tumor necrosis factor alpha antagonists in the Mediterranean basin. A switch in clinical expression. PLoS Negl Trop Dis 2019; 13:e0007708. [PMID: 31469834 PMCID: PMC6742442 DOI: 10.1371/journal.pntd.0007708] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/12/2019] [Accepted: 08/15/2019] [Indexed: 02/02/2023] Open
Abstract
Background Tumor necrosis factor alpha (TNF-α) blockers are recognized as a risk factor for reactivation of granulomatous infections. Leishmaniasis has been associated with the use of these drugs, although few cases have been reported. Methodology We performed a retrospective observational study including patients with confirmed leishmaniasis acquired in the Mediterranean basin that were under TNF-α blockers therapy at the moment of the diagnosis. Patients diagnosed in our hospital from 2008 to 2018 were included. Moreover, a systematic review of the literature was performed and cases fulfilling the inclusion criteria were also included. Principal findings Forty-nine patients were analyzed including nine cases from our series. Twenty-seven (55.1%) cases were male and median age was 55 years. Twenty-five (51%) patients were under infliximab treatment, 20 (40.8%) were receiving adalimumab, 2 (4.1%) etanercept, one (2%) golimumab and one (2%) a non-specified TNF-α blocker. Regarding clinical presentation, 28 (57.1%) presented as cutaneous leishmaniasis (CL), 16 (32.6%) as visceral leishmaniasis (VL) and 5 (10.2%) as mucocutaneous leishmaniasis (MCL). All VL and MCL patients were treated with systemic therapies. Among CL patients, 13 (46.4%) were treated with a systemic drug (11 received L-AmB, one intramuscular antimonials and one miltefosine) while 14 (50%) patients were given local treatment (13 received intralesional pentavalent antimonials, and one excisional surgery). TNF-α blockers were interrupted in 32 patients (65.3%). After treatment 5 patients (10.2%) relapsed. Four patients with a CL (3 initially treated with local therapy maintaining TNF-α blockers and one treated with miltefosine) and one patient with VL treated with L-AmB maintaining TNF-α blockers. Conclusions This data supports the assumption that the blockage of TNF-α modifies clinical expression of leishmaniasis in endemic population modulating the expression of the disease leading to atypical presentations. According to the cases reported, the best treatment strategy would be a systemic drug and the discontinuation of the TNF-α blockers therapy until clinical resolution. Tumor necrosis factor alpha (TNF-α) blockers are widely used in numerous inflammatory diseases such rheumatoid arthritis, psoriasis or inflammatory bowel diseases. They have been recognized as a risk factor for reactivation of granulomatous infections. Although few cases have been reported, Leishmaniasis has been associated with the use of these drugs. Leishmania infantum is the main causative agent of leishmaniasis in Southern Europe and is prone to produce the visceral form. However, TNF-α has been implicated in the initial events of the infection mediating the disease expression. In our series, we have observed a surprisingly high proportion of cutaneous form (32.6%) and muco-cutaneous form (10.2%). Clinical outcome observed in this series is also unusual. Four cases (14.3%) with cutaneous leishmaniasis who received local therapy relapsed. Among patients with visceral leishmaniasis, one patient who maintained TNF-α blockers therapy relapsed despite etiological treatment. This data supports the assumption that the blockage of TNF-α modifies clinical expression of leishmaniasis leading to atypical presentations. According to the cases reported we proposed as best treatment strategy a systemic drug and the discontinuation of the TNF-α blockers therapy until clinical resolution.
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Affiliation(s)
- Pau Bosch-Nicolau
- Department of Infectious Diseases, Hospital Universitari Vall d’Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Spain
| | - Maria Ubals
- Department of Dermatology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Fernando Salvador
- Department of Infectious Diseases, Hospital Universitari Vall d’Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Spain
| | - Adrián Sánchez-Montalvá
- Department of Infectious Diseases, Hospital Universitari Vall d’Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Spain
| | - Gloria Aparicio
- Department of Dermatology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Alba Erra
- Department of Rheumatology, Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Spain
| | - Pablo Martinez de Salazar
- Department of Clinical Microbiology, Hospital Universitari Vall d’Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Spain
| | - Elena Sulleiro
- Department of Clinical Microbiology, Hospital Universitari Vall d’Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Spain
| | - Israel Molina
- Department of Infectious Diseases, Hospital Universitari Vall d’Hebron, PROSICS Barcelona, Universitat Autònoma de Barcelona, Spain
- * E-mail:
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Català A, Roé E, Dalmau J, Pomar V, Muñoz C, Yelamos O, Puig L. Anti-Tumour Necrosis Factor-Induced Visceral and Cutaneous Leishmaniasis: Case Report and Review of the Literature. Dermatology 2015; 230:204-7. [DOI: 10.1159/000370238] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 12/01/2014] [Indexed: 11/19/2022] Open
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Leishmaniasis cutánea en un paciente con artritis psoriásica tratado con infliximab: tratamiento con crioterapia y Glucantime® intralesional. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:714-6. [DOI: 10.1016/j.ad.2013.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 06/25/2013] [Accepted: 08/19/2013] [Indexed: 11/24/2022] Open
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Català A, Barnadas M, Muñoz C, Puig L. Cutaneous Leishmaniasis in a Patient Receiving Infliximab for Psoriatic Arthritis: Treatment with Cryotherapy and Intralesional Meglumine Antimonate. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2014.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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van Griensven J, Carrillo E, López-Vélez R, Lynen L, Moreno J. Leishmaniasis in immunosuppressed individuals. Clin Microbiol Infect 2014; 20:286-99. [DOI: 10.1111/1469-0691.12556] [Citation(s) in RCA: 227] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Neumayr AL, Morizot G, Visser LG, Lockwood DN, Beck BR, Schneider S, Bellaud G, Cordoliani F, Foulet F, Laffitte EA, Buffet P, Blum JA. Clinical aspects and management of cutaneous leishmaniasis in rheumatoid patients treated with TNF-α antagonists. Travel Med Infect Dis 2013; 11:412-20. [DOI: 10.1016/j.tmaid.2013.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 05/09/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
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Guedes-Barbosa LS, Pereira da Costa I, Fernandes V, Henrique da Mota LM, de Menezes I, Aaron Scheinberg M. Leishmaniasis during anti-tumor necrosis factor therapy: report of 4 cases and review of the literature (additional 28 cases). Semin Arthritis Rheum 2013; 43:152-7. [PMID: 23777708 DOI: 10.1016/j.semarthrit.2013.01.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 01/30/2013] [Accepted: 01/31/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To describe the development of 4 new cases of leishmaniasis in patients receiving anti-tumor necrosis factor-α (anti-TNF) agents and review the pertinent literature. METHODS Chart review of the 4 cases and MEDLINE search for additional reported cases. RESULTS All reported cases, including ours, came from endemic areas. The infection was detected on an average of 23.5 months after the initiation of anti-TNF therapy. The majority of cases had the classical clinical presentation. The biological therapy was suspended in 21 cases. The results were successful for leishmaniasis therapy in all cases. In 10 cases it was possible to reintroduce anti-TNF agents. On follow-up it was observed that there was an infection relapse in 3 cases. CONCLUSIONS The present study shows that leishmaniasis, in its several clinical forms, should be included in the differential diagnosis of possible infections involving patients under use of aTNF therapy. Endemic disease under geographic expansion, easy international displacement and intense human migratory flows certainly represents a risk of this infection in an increasing universe of people which includes the immunosuppressed patients. Cutaneous lesions, prolonged fever, splenomegaly, and pancytopenias, the main clinical-laboratory findings of leishmaniasis, can also be present in autoimmune rheumatic disease, thus leading to delayed diagnosis and treatment of the parasitic disease. The diagnosis depends basically on a high suspicion index, being confirmed with the identification of the protozoan. The classic treatment of the infection when instituted is associated with complete recovery. It is important to point out that all cases reported so far had either originated from or been recently in regions regarded as endemic of leishmaniasis.
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Hernández-Torres A, García-Vázquez E, Frías-Iniesta J, Herrero-Martínez JA, Gómez-Gómez J. Cutaneous leishmaniasis in a patient receiving infliximab. ACTA ACUST UNITED AC 2012; 45:567-9. [DOI: 10.3109/00365548.2012.752859] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Nylén S, Eidsmo L. Tissue damage and immunity in cutaneous leishmaniasis. Parasite Immunol 2012; 34:551-61. [DOI: 10.1111/pim.12007] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 09/17/2012] [Indexed: 12/21/2022]
Affiliation(s)
- S. Nylén
- Department of Microbiology; Tumor and Cell Biology; Karolinska Institutet; Stockholm; Sweden
| | - L. Eidsmo
- Molecular Dermatology; Department of Medicine Solna; Karolinska Institutet; Stockholm; Sweden
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Zanger P, Kötter I, Kremsner P, Gabrysch S. Tumor necrosis factor alpha antagonist drugs and leishmaniasis in Europe. Clin Microbiol Infect 2012; 18:670-6. [DOI: 10.1111/j.1469-0691.2011.03674.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Garcia-Gonzalez E, Guidelli GM, Bardelli M, Maggio R. Mucocutaneous leishmaniasis in a patient treated with anti-TNF- therapy. Rheumatology (Oxford) 2012; 51:1517-8. [DOI: 10.1093/rheumatology/kes030] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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[Persistent inflammation of the nasal dorsum in a patient with rheumatoid arthritis treated with infliximab]. Enferm Infecc Microbiol Clin 2011; 30:40-2. [PMID: 21903302 DOI: 10.1016/j.eimc.2011.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 05/28/2011] [Accepted: 06/29/2011] [Indexed: 11/24/2022]
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