Reactivation of Mucosal and Cutaneous Leishmaniasis in a Renal Transplanted Patient

Abstract

Abstract. Mucosal leishmaniasis (ML) is a chronic form of tegumentary leishmaniasis, which causes destructive lesions of nasal, pharyngeal, and laryngeal mucosa. We describe a case of leishmaniasis reactivation with simultaneous cutaneous and mucosal forms in a renal transplanted patient with no history of prior leishmaniasis. Reactivation after renal transplantation was not reported in Brazil. A 67-year-old woman receiving prednisone 20 mg/day, tacrolimus 1 mg/day, and mycophenolic acid 360 mg/day presented with nose edema with erythema and cutaneous lesions. Amastigotes were identified on biopsies and the polymerase chain reaction confirmed Leishmania (Viannia) braziliensis. The patient was treated with liposomal amphotericin B but died 3 weeks after as a result of bacterial septic shock. In conclusion, tegumentary leishmaniasis can reactivate with simultaneous cutaneous and mucosal forms in a renal transplanted patient during the immunosuppressant therapy.

Mucosal leishmaniasis mimicking squamous cell carcinoma in a liver transplant recipient

“…ML has been described in 8 solid organ transplantation recipients (7 kidney recipients and 1 heart recipient) . To our knowledge, this is the first reported case of ML in a liver transplant patient.…”

Case Reports: Late Emergence of Cutaneous Leishmaniasis in an Immunocompromised Patient in a Non-Endemic Setting

“…5 A report from Brazil described reactivation 1 year after transplant while on tacrolimus, mycophenolate, and prednisolone. 6 Another report from Brazil describes reactivation of cutaneous leishmaniasis after 2 years in the context of corticosteroid treatment for rheumatoid arthritis. 7 A patient originally from Bolivia but who received a kidney transplant in America had reactivation of cutaneous leishmaniasis 9 months after last exposure while on tacrolimus and methylprednisolone.…”

Chagas Disease, Leishmaniasis, and Malaria in Solid Organ Transplant Recipients

“…Concurrent cutaneous and visceral leishmaniasis has been observed among kidney and liver transplant recipients and both typical and atypical presentation of CL are reported in the literature [86][87][88][89][90]. Mucosal leishmaniasis localised on the tongue, lip, labial commissure, and nose has been described among SOT patients almost exclusively in the Mediterranean basin where the species responsible is L. infantum [68,[91][92][93][94][95]. Relapse of VL was reported in 26% to 28% of SOT patients and in one of these studies, more frequently among patients not receiving prophylaxis (34.8%) than those receiving prophylaxis (8.3%), with a p value of 0.19 [79,81].…”