Anti‐tumour necrosis factor‐associated cutaneous leishmaniasis: a single‐institution experience

Martínez‐Doménech, Álvaro; García-Legaz-Martínez, Marta; Magdaleno‐Tapial, Jorge; Torrecillas, Miriam; Hernández-Bel, P.; Mochón, María Dolores Ocete; Pérez‐Ferriols, A.; Miquel, Víctor Alegre de

doi:10.1111/bjd.17644

Cited by 7 publications

(12 citation statements)

References 8 publications

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“…A total of 33 publications were retrieved in our search including forty cases that fulfilled inclusion criteria [8–39]. Thus, a total of 49 cases were analyzed including our 9 cases (Table 1).…”

Section: Resultsmentioning

confidence: 99%

Leishmaniasis and tumor necrosis factor alpha antagonists in the Mediterranean basin. A switch in clinical expression

Bosch-Nicolau¹,

Ubals²,

Salvador³

et al. 2019

PLoS Negl Trop Dis

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BackgroundTumor 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.MethodologyWe 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 findingsForty-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.ConclusionsThis 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.

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Section: Resultsmentioning

confidence: 99%

Leishmaniasis and tumor necrosis factor alpha antagonists in the Mediterranean basin. A switch in clinical expression

Bosch-Nicolau¹,

Ubals²,

Salvador³

et al. 2019

PLoS Negl Trop Dis

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“…In a case series of six patients with CL, Martínez-Domenech et al found no cases of relapse or progression within a range of 1 and 28 months of follow-up. 36 On the other hand, Bosch-Nicolau et al found four cases of relapse out of 28 patients with CL. 37 These authors defined relapse as reappearance of clinical signs after treatment discontinuation during the first year of follow-up or after this period if it could be microbiologically demonstrated.…”

Section: Discussionmentioning

confidence: 97%

“…Six of these 49 cases are included in our multicenter study, and we are also including 32 new cases of anti TNF-associated CL and MCL. 36 The role of TNF-α inhibitors favoring leishmania infections, in any of its three forms, is unquestionable and has been extensively demonstrated in vitro and in vivo. [38][39][40][41] This risk is greater with monoclonal antibodies blocking the TNF-α receptor, such as adalimumab and infliximab, and seems to be lower with etanercept and certolizumab.…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological characteristics of cutaneous and mucocutaneous leishmaniasis in patients treated with TNF‐α inhibitors

Palacios-Diaz

Sahuquillo‐Torralba

Rocamora-Durán

et al. 2023

J Deutsche Derma Gesell

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Summary Background and objectives The increasing use of biologics in the treatment of inflammatory diseases has led to more cases of leishmaniasis in patients subjected to iatrogenic immunosuppression. The main objective was to describe the characteristics of the patients with cutaneous (CL) or mucocutaneous (MCL) leishmaniasis who were receiving a biological therapy at the time of diagnosis. Patients and methods A multicenter retrospective study was design based on a cohort of patients diagnosed with CL or MCL. All patients who were being treated with biologicals were included. For each case, two matched non‐exposed patients were included for comparison. Results 38 patients were diagnosed with CL or MCL while being treated with tumor necrosis factor alpha (TNF‐α) inhibitors. Leishmaniasis presented more frequently as a plaque (58.3%) with a larger median lesion size (2.5 cm), ulceration (92.1%), and required a greater median number of intralesional meglumine antimoniate infiltrations (3 doses) (P < 0.05) than in non‐exposed patients. We found no systemic involvement in patients being treated with anti‐TNF‐α. We did not find differences regarding the treatment characteristics whether biologic therapy was modified or not. Conclusions Although management should be individualized, maintenance of biologic therapy does not seem to interfere with treatment of CL or MCL.

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“…Anti-TNF-a treatment should be discontinued in patients with CL but can be reintroduced after resolution of the infection. 3,4 Herein we report a unique case of CL with vegetative zosteriform presentation triggered by anti-TNF-a therapy for psoriasis.…”

Section: Clinical Coursementioning

confidence: 98%

“…Leishmania parasites were isolated using Novy-MacNeal-Nicolle (NNN) and Schneider's medium. The involved species was Leish- treated with TNF-a inhibitors, 3,4 occasionally with development of large cutaneous lesions. 5 In our patient, adalimumab may have been responsible for the persistent unusually large multifocal lesions distributed along the T6-T7 dermatomes.…”

Section: Clinical Coursementioning

confidence: 99%

Erythematous plaques with zosteriform distribution in a patient treated with TNF‐α inhibitor adalimumab for psoriasis

et al. 2021

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Anti‐tumour necrosis factor‐associated cutaneous leishmaniasis: a single‐institution experience

Cited by 7 publications

References 8 publications

Leishmaniasis and tumor necrosis factor alpha antagonists in the Mediterranean basin. A switch in clinical expression

Leishmaniasis and tumor necrosis factor alpha antagonists in the Mediterranean basin. A switch in clinical expression

Clinicopathological characteristics of cutaneous and mucocutaneous leishmaniasis in patients treated with TNF‐α inhibitors

Erythematous plaques with zosteriform distribution in a patient treated with TNF‐α inhibitor adalimumab for psoriasis

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