Atypical presentation of cutaneous leishmaniasis in a renal transplant recipient successfully treated with allopurinol and fluconazole

Yaïch, S.; Charfeddine, K.; Masmoudi, Abderrahmen; Masmoudi, Mohamed; Zaghdhane, Sawssen; Turki, H.; Hachicha, J.

doi:10.5144/0256-4947.2012.01.7.1510

Cited by 16 publications

(24 citation statements)

References 16 publications

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“…A vast number of cases of CL and ML have been reported in immunosuppressed individuals. Besides series of HIV-infected patients [18,159] and transplantation cases [31,[160][161][162], there are also reports of reactivation of infection after initiation of immunosuppressive drugs such as anti-TNF-a agents [163][164][165] and steroids [51,[166][167][168]. Although the clinical presentation will often be similar to that in immunocompetent individuals, a number of particular features have been reported, especially in cases of severe immunosuppression.…”

Section: And MLmentioning

confidence: 99%

Leishmaniasis in immunosuppressed individuals

Griensven

Carrillo

López‐Vélez³

et al. 2014

Clinical Microbiology and Infection

283

244

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Leishmaniasis is a vector-born chronic infectious disease caused by a group of protozoan parasites of the genus Leishmania. Whereas most immunocompetent individuals will not develop disease after Leishmania infection, immunosuppression is a well-established risk factor for disease. The most severe form is visceral leishmaniasis (VL), which is typically fatal if untreated. Whereas human immunodeficiency virus (HIV) co-infection (VL-HIV) was initially mainly reported from southern Europe, it is now emerging in other regions, including East Africa, India, and Brazil. VL has also been found in a wide range of non-HIV-related immunosuppressive states, mainly falling under the realm of transplantation medicine, rheumatology, haematology, and oncology. Clinical presentation can be atypical in immunosuppressed individuals, being easily misdiagnosed or mistaken as a flare-up of the underlying disease. The best diagnostic approach is the combination of parasitological and serological or molecular methods. Liposomal amphotericin B is the drug of choice. Treatment failure and relapse rates are particularly high in cases of HIV co-infection, despite initiation of antiretroviral treatment. Primary prophylaxis is not recommended, but secondary prophylaxis is recommended when the patient is immunosuppressed. Cutaneous leishmaniasis can have a number of particular features in individuals with immunosuppression, especially if severe, including parasite dissemination, clinical polymorphism with atypical and often more severe clinical forms, and even visceralization. Mucosal leishmaniasis is more common. Treatment of cutaneous and mucosal leishmaniasis can be challenging, and systemic treatment is more often indicated. With globally increased travel and access to advanced medical care in developing countries, the leishmaniasis burden in immunosuppressed individuals will probably continue to rise, warranting increased awareness and enhanced surveillance systems.

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Section: And MLmentioning

confidence: 99%

Leishmaniasis in immunosuppressed individuals

Griensven

Carrillo

López‐Vélez³

et al. 2014

Clinical Microbiology and Infection

283

244

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“…In a Spanish study, the prevalence of asymptomatic Leishmania infection by serological technique was 4.8%, but other series report up to 30% of asymptomatic patients [ 31 ]. Leishmaniasis usually presents with a medium delay of 19 months after KT, although considering all SOT, the medium delay is about 11 months [ 1 , 5 , 11 , 32 ]. There is a paucity of information regarding risk factors among SOT for the development of leishmaniasis.…”

Section: Discussionmentioning

confidence: 99%

Visceral Dissemination of Mucocutaneous Leishmaniasis in a Kidney Transplant Recipient

et al. 2020

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Intracellular protozoan of the genus Leishmania, endemic in the Mediterranean basin, are the cause of cutaneous (CL), mucocutaneous (MCL), and visceral leishmaniasis (VL). A 75-year-old woman was admitted nine years after a second kidney transplant (KT), due to persistent pancytopenia and fever. She presented edema and erythema of the nose in the last two years and an exophytic nodular lesion located on the left arm, with areas of peripheral necrosis and central ulceration in the last 18 months. A bone marrow biopsy revealed features compatible with Leishmania amastigotes, and polymerase chain reaction test (PCR) for Leishmania infantum was positive. Moreover, biopsy and PCR for L. infantum of the cutaneous lesion on the patient’s left arm and nose and PCR from peripheral blood were positive. Thus, a diagnosis of CL, MCL, and VL was made, and liposomal amphotericin B was initiated, but the patient had an unfavorable outcome and died. This is the first report of a KT recipient presenting with the entire spectrum of leishmaniasis. In Portugal, this infection is rare—so a high degree of clinical suspicion is required for its diagnosis, especially in endemic regions, as visceral leishmaniasis is a potentially life-threatening infection.

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“…The recommended treatment for visceral leishmaniasis in a transplant patient is amphotericin B (AmB) . One alternative treatment is allopurinol combined with fluconazole, which is an inexpensive, well tolerated regimen that is mainly used in cases of treatment failure or relapses after more conventional treatments (with AmB or antimonials) .…”

Section: Discussionmentioning

confidence: 99%

Mucosal leishmaniasis mimicking squamous cell carcinoma in a liver transplant recipient

Ramos

Múñez

García-Domínguez

et al. 2015

Transplant Infectious Dis

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Organ transplant recipients living in endemic regions are at increased risk of Leishmania infections. Visceral leishmaniasis is the most common kind of presentation in the Mediterranean basin. Rarely, Leishmania infantum may cause localized mucosal disease. We present the first case, to our knowledge, of a liver transplant recipient with localized mucosal leishmaniasis. Twenty-two years after transplantation, a painless, very slow growing ulcer appeared on the inner side of the patient's upper lip. A biopsy performed in the community hospital showed non-specific chronic inflammation without neoplastic signs. Because of a high suspicion of malignancy, the patient was transferred to the referral hospital to consider complete excision. The excisional biopsy revealed a granulomatous inflammatory reaction together with intracellular Leishmania amastigotes within macrophages. Leishmaniasis was confirmed by the nested polymerase chain reaction assay. The clinical and laboratory findings did not suggest visceral involvement. The patient received meglumine antimoniate for 21 days without relevant adverse effects.

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Atypical presentation of cutaneous leishmaniasis in a renal transplant recipient successfully treated with allopurinol and fluconazole

Cited by 16 publications

References 16 publications

Leishmaniasis in immunosuppressed individuals

Leishmaniasis in immunosuppressed individuals

Visceral Dissemination of Mucocutaneous Leishmaniasis in a Kidney Transplant Recipient

Mucosal leishmaniasis mimicking squamous cell carcinoma in a liver transplant recipient

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