Use of tumor necrosis factor alpha (TNF α) antagonists in a patient with psoriasis and Chagas disease

Abstract

There are several studies on the benefits of using TNFα antagonists in the treatment of psoriasis, but few studies addressing the interaction of these drugs with chronic infections. We report the case of a 52-year-old patient diagnosed with psoriasis refractory to traditional systemic agents, who was treated with biologic therapies. After one year of treatment with biologic agents, the patient was diagnosed with Chagas Disease.

TNF blockers alone and associated with Benznidazole impact in vitro cytokine dynamics in chronic Chagas disease

“…24,28 The effects of these immunomodulatory drugs on the course of Chagas disease in humans are unknown. 29 In our study, ADA in vitro drastically reduced the production of TNF by the mononuclear cells of all patients, with its lowest level in the CARD2 group (Figure 2B,C). On the other hand, ETA did not significantly inhibit TNF levels in all groups compared to the experimental condition without treatment, except for the CARD2 group.…”

“…In the case report described by Navarrete-Dechent et al, the follow-up using quantification of the parasite's DNA in the blood by RT-PCR did not show any evidence of Chagas disease reactivation with the use of ETA or ADA. 29 These data may be a promising alternative for these chronic carriers who no longer benefit from the etiological treatment. The association with TNF inhibitors should be investigated in more detail, especially regarding the reactivation of other diseases.…”

“…The patient had to receive both drugs (Nifurtimox + Adalimumab), and it was a success; the Chagas disease was not reactivated and the controlled autoimmune disease. 29 Studies involving this approach should be encouraged since Chagas disease is a chronic pathology and, in most cases, of slow evolution; many patients do not know they have the disease, since 70% are in the asymptomatic form, with a typical image. [1][2][3][4][5][6][7] Many discover by chance when they donate blood or an organ transplant.…”

“…TNF inhibitors are among the most successful drugs in the treatment of chronic inflammatory and autoimmune diseases such as arthritis, especially rheumatoid arthritis, ankylosing spondylitis and inflammatory bowel diseases, in addition to many case studies involving these biologics and parasitic diseases, such as Leishmaniasis 24,28 . The effects of these immunomodulatory drugs on the course of Chagas disease in humans are unknown 29 …”

Reactivation of Chagas Disease in a Patient With an Autoimmune Rheumatic Disease: Case Report and Review of the Literature

“…Two other patients presented with Chagas skin lesions [ 30 , 32 ], 1 of whom suffered recurrent disease after a course of benznidazole [ 30 ]. Other cases describe asymptomatic reactivation detected by T. cruzi PCR [ 33 , 34 ], for which 1 patient was treated with off-label posaconazole after failing therapy with benznidazole [ 33 ]. The remaining patient reports describe possible reactivation detected through T. cruzi blood PCR positivity on a single test [ 30 , 35 ]; given the absence of symptoms and serial testing, it is unclear if these patients had true CD reactivation or merely intermittently detectable parasites associated with chronic CD.…”