Leishmania infection in psoriasis

Abstract

In this Journal Brunet and colleagues 1 discussed reactivation of latent infections in the context of chronic disease, solid organ transplantation or long-term immunosuppressive treatment. We recently observed the reactivation of Leishmania infection in a 46-year-old patient receiving methotrexate for psoriasis, who was diagnosed with visceral leishmaniasis (VL) showing a mucocutaneous involvement. We analyzed the epidemiologic and clinical characteristics of all cases of leishmaniasis in patients with psoriasis found through a review of the literature. Our patient was admitted into the Infectious Disease Unit of Paolo Giaccone hospital, in Palermo, with a painless and ulcerated lesion onto the oral mucosa (Fig. 1a), two nodular ulcerated lesions on the right knee and another one on instep of the right foot appeared one month before (Fig. 1b). The patient did not travel outside Italy during the last year. He had been suffering from lowgrade fever in the last month. Considering the above findings leishmaniasis was suspected and a needle aspiration of oral and cutaneous lesions was arranged in order to perform microscopy and Leishmania-PCR, which were positive for Leishmania. Laboratory tests exhibited: WBC 4970/mmc, Hb 13.9 g/dl, C Reactive Protein, 26.9 mg/L; positive serology for Leishmania (IgG 1/3200) and positive Leishmania-PCR test on peripheral blood. Abdominal US examination revealed splenomegaly (14 cm); methotrexate was suspended and liposomal Amphotericin B, 4 mg/kg per day for 10 days, followed by two further administrations two weeks later was started. Cutaneous and mucosal lesions improved at the end of the first 10 days of therapy and completely vanished after two further administrations, 40 days from the beginning of treatment. Leishmania-PCR on peripheral blood after 10 days of therapy was negative.

Mucosal Relapse of Visceral Leishmaniasis in a Child with SARS-CoV-2 Infection

“…Sicily, as part of the Mediterranean basin, is considered to be an endemic area for VL caused by L. infantum [ 2 ], which is characterized by the symptomatologic triad of fever, pancytopenia, and hepatosplenomegaly. In this region, L. infantum can also be responsible for a localized CL, while mucosal involvement is described in the literature almost exclusively in HIV+ or immunosuppressed patients [ 19 ].…”

“…A reduction in the therapeutic response and high recurrence rates are described almost exclusively in immunocompromised patients [ 17 , 21 ], where Leishmania parasites can persist for decades after treatment and reactivation of the infection can occur due to an impaired cell-mediated immune response [ 19 , 22 , 23 ]. The host immune system, and in particular, the specific cell-mediated immune response, are of crucial importance in determining the clinical outcome of infection.…”

Third Case of Visceral Leishmaniasis in COVID-19: Mini Review Article

“…The clinical presentation of VL in immunocompromised patients is similar to that observed in immunocompetent individuals. The main difference is the lower rate of response to treatment and the subsequent high rate of disease relapse [13,[17][18][19][20].…”

Visceral Leishmaniasis after Anti-Interleukin 17A (IL-17A) Therapy in a Patient Affected by Psoriatic Arthritis

“…VL is usually characterized by prolonged fever, weight loss, splenomegaly and hepatomegaly, progressive anemia or pancytopenia and hypergammaglobulinemia [ 7 ]. Moreover, the reactivation of latent Leishmania infection in chronic diseases and immunocompromised hosts is a broad and heterogeneous field in medicine and infectious diseases [ 11 , 12 , 13 ]. In particular, among patients with psoriasis, with or without psoriatic arthritis, reported cases of Leishmania infections and reactivations are growing in the literature [ 12 ].…”

“…Leishmaniasis frequently occurs subclinically in immunocompetent subjects [ 7 ]. Moreover, within the leishmaniasis disease spectrum, VL is well known to be at greater risk of reactivation in immunocompromised hosts, most notably in PLWHA and patients undergoing immunosuppressive regimens [ 11 , 12 , 13 ]. Indeed, such cases have been increasingly reported in the literature lately, although none of them was found to be associated with IL-17 inhibitors [ 11 ].…”