Cutaneous leishmaniasis associated with anti-tumour necrosis factor-α drugs: an emerging disease

Abstract

Leishmaniasis is endemic in several geographic areas of the world. In each of these areas, particular species of Leishmania with differing aggressiveness to humans predominate. In the European Mediterranean basin, cutaneous leishmaniasis usually presents with discrete, self-healing skin lesions. Although it is known that tumour necrosis factor (TNF) inhibitors may increase the risk of developing infections such as tuberculosis, there is scarce literature on Leishmania infections in patients treated with these drugs. In recent months, we have observed three patients resident in the Catalan coast of Spain who were treated with TNF inhibitors for Crohn disease, and who developed unusually large and persistent cutaneous lesions of leishmaniasis. These lesions responded only to treatment with intravenous liposomal amphotericin B. In countries with a high incidence of infection by aggressive species of Leishmania, serological screening may be indicated to detect a possible latent leishmanial infection before prescription of TNF inhibitors.

Cutaneous leishmaniasis associated with TNF-α blockers: a case report

“…in developed countries. This increase seems to be related to the greater use of anti-TNF agents for the treatment of autoimmune diseases (rheumatoid arthritis, psoriasis, psoriatic arthritis) increasingly common in our community 7. This biological treatment leads to immunosuppression, which makes the reactivation of leishmaniasis more plausible, as reflected in the case described.…”

Evolution of cutaneous leishmaniasis in the last 30 years in a tertiary hospital of the European Mediterranean coast

“…In the 1990s, most cases observed in immunocompromised patients were associated with human immunodeficiency virus (HIV) infection. In recent years, the number of cases associated with AIDS has decreased, probably because of antiretroviral treatment, while in the last 2 years new cases of cutaneous leishmaniasis associated with treatment with anti‐TNF agents have appeared in our population (3 of these cases have been previously reported) . TNF‐ α is a proinflammatory cytokine that is involved in the immune response against several infections including leishmaniasis .…”

Visceral leishmaniasis in a patient with ulcerative colitis: A case report

“…Patients previously treated with more than two immunosuppressive drugs are at particular risk for opportunistic infections 11 . Opportunistic infections have been increasingly reported in anti-tumor necrosis factor (TNF)-treated patients 12 , but publications on Leishmania infections in patients treated with TNF inhibitors are still not frequent 11,13,14 . In the presented case VL occurred in an immunocompromised malnourished patient with severe relapse of autoimmune disease treated with two immunosuppressants.…”

“…He was treated with antimony with a regression of the local findings, but on the 24th day after his admission, the patient suddenly expired due to fatal arrhythmia as a side effect of the treatment with antimony. In a recent report three cases of Catalan coast residents who were treated with TNF inhibitors for Crohn's disease, developed atypical cutaneous lesions of leishmaniasis 13 . In none of the cases Leishmania was detected microscopically; diagnosis was confirmed by PCR of skin samples, serology testing and response to treatment.…”

“…In none of the cases Leishmania was detected microscopically; diagnosis was confirmed by PCR of skin samples, serology testing and response to treatment. They received systemic treatment with liposomal amphotericin B because of the lack of response to antimony intralesional treatment in 2 patients and because of hepatosplenomegaly in the third 13 .…”