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

Abstract

Leishmaniasis is a chronic protozoan disease that is found in diverse geographical areas of the world. Leishmania spp. are endemic in the Mediterranean coasts of southern Europe. Tumour necrosis factor alpha (TNF-α) plays an important role in the defence of the host against infection by Leishmania spp. In this case report we describe Leishmania infection caused by a monoclonal antibody against TNF-α: infliximab. A 51-year-old patient with psoriatic arthritis treated with infliximab, 5 mg/kg every 6 weeks as immunomodulatory treatment and methotrexate 10 mg weekly as a conventional disease-modifying antirheumatic drug, visited his otorhinolaryngologist owing to a lesion in his left nostril. The lesion was diagnosed as cutaneous leishmaniasis so treatment with infliximab was suspended. The patient was then treated with liposomal amphotericin B and showed a total recovery of the lesion; liposomal amphotericin B was maintained at 5 mg/kg monthly.

TNF-α Triggers RIP1/FADD/Caspase-8-Mediated Apoptosis of Astrocytes and RIP3/MLKL-Mediated Necroptosis of Neurons Induced by Angiostrongylus cantonensis Infection

“…Tumour necrosis factor-α (TNF-α) is one of the most important pro-inflammatory cytokines (Akash et al 2018 ; Al-Gayyar and Elsherbiny 2013 ), is mainly secreted by macrophage-like cells and functions to regulate the processes of inflammation (Zelova and Hosek 2013 ), apoptosis (Naimi et al 2018 ) and necroptosis (Gunther et al 2011 ) by the way of the paracrine system (Lin et al 2018 ; Ye et al 2013 ). Parasitic infections often lead to the upregulation of TNF-α, which was observed in cases infected with various parasites including A. cantonensis, Leishmania braziliensis (Nieto Gomez et al 2019 ; Polari et al 2019 ; Schwartz et al 2018 ), Plasmodium (Grau and Lou 1995 ) and Toxoplasma gondii (Park et al 2019 ; Pego et al 2019 ). As a high level of TNF-α tends to be positively correlated with poor pathological outcomes of patients, an inhibitor of TNF-α has been used to improve the symptoms in some cases (Zhou et al 2020 ), indicating that TNF-α signalling could be a promising therapeutic target.…”

Cutaneous leishmaniasis induced by TNF‐α blockers: a diagnostic challenge

“…Leishmaniasis is a parasitic disease and to consider that TNF blocker causes or triggers it as a previous infection (leishmaniasis recidivans) should be stated. Therefore, a possibly coincidental association rather than induced by TNF inhibitors cannot be ruled out in our case or those previously published 1,2,4,5,10 …”

“…Leishmaniasis is a chronic disease caused by protozoa of the Leishmania genus, endemic on the Mediterranean coasts of southern Europe 1 . Tumor necrosis factor alpha (TNF‐α) plays a fundamental role in the defense of the host against infection 2 .…”