The severity of SDB was independently associated with greater aggressiveness of cutaneous melanoma, particularly among younger patients.

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Background: Leishmaniasis is a chronic protozoan disease in which organisms are found within phagolysosomes of the mononuclear phagocyte system. There are three major forms: cutaneous, mucocutaneous and visceral. We report the first case of visceral leishmaniasis with cutaneous involvement in a patient with rheumatoid arthritis treated with the anti-tumour necrosis factor (anti-TNF) adalimumab. Objective: To highlight cutaneous leishmaniasis as the first indicator of a kala-azar disease in a patient treated with anti-TNF and to review the literature on leishmaniasis in the context of anti-TNF therapy. Case Report: A 59-year-old woman presented with a crusted plaque on the right elbow 34 months after the initiation of adalimumab. A cutaneous biopsy showed intracellular amastigotes. No Leishmania parasites were observed in a bone marrow aspirate, but laboratory tests showed anaemia and impaired liver function, abdominal ultrasonography showed hepatomegaly, and ELISA serology was strongly positive for Leishmania antibodies in serum and urine. Adalimumab was withdrawn and treatment combining intralesional pentavalent antimonials and liposomal amphotericin was started. Eight weeks later, the leishmaniasis had resolved. Conclusion: A skin biopsy disclosing leishmaniasis should prompt tests to rule out visceral leishmaniasis, especially in an area such as the Mediterranean where the prevalence of latent Leishmania infection is high.

True leuconychia results from a structural abnormality of the nail plate. It is thought to be due to a defect in keratinization with persistence of keratohyaline granules and air trapping within the nail. 5 Our patient presents with true transverse leuconychia of her thumbnails and fingernails which resolved spontaneously during the third trimester of both her pregnancies. The leuconychia decreased in intensity from the thumb to the little finger on both hands and was also associated with transverse yellow bands, most prominent on her thumbnails. Neither phenomenon is readily explained. The menstrual cycle has previously been reported as a cause of transverse leuconychia. 4 The onset of our patient's leuconychia with the commencement of her menses and its 'disappearance' and subsequent 'reappearance' during and following each pregnancy also implies a hormonal influence. The exact aetiology of her leuconychia remains unknown. No similar cases have been reported to date.