Visceral leishmaniasis with cutaneous symptoms in a patient treated with infliximab followed by fatal consequences

Jůzlová, Kateřina; Votrubová, Jana; Kacerovská, Denisa; Lukáš, Milan; Bortlík, Martin; Roháčová, Hana; Nohýnková, Eva; Vojáčková, Naděžda; Fialová, Jorga; Hercogová, Jana

doi:10.1111/dth.12083

Cited by 12 publications

(6 citation statements)

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“…The first case of a possible association between an anti‐TNF and leishmania infection was reported in 2004 5 . Since then, 49 cases of leishmaniasis in patients treated with an anti‐TNF biologic drug have been reported 6–37 . Six of these 49 cases are included in our multicenter study, and we are also including 32 new cases of anti TNF‐associated CL and MCL 36 .…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological characteristics of cutaneous and mucocutaneous leishmaniasis in patients treated with TNF‐α inhibitors

Palacios-Diaz

Sahuquillo‐Torralba

Rocamora-Durán

et al. 2023

J Deutsche Derma Gesell

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Summary Background and objectives The increasing use of biologics in the treatment of inflammatory diseases has led to more cases of leishmaniasis in patients subjected to iatrogenic immunosuppression. The main objective was to describe the characteristics of the patients with cutaneous (CL) or mucocutaneous (MCL) leishmaniasis who were receiving a biological therapy at the time of diagnosis. Patients and methods A multicenter retrospective study was design based on a cohort of patients diagnosed with CL or MCL. All patients who were being treated with biologicals were included. For each case, two matched non‐exposed patients were included for comparison. Results 38 patients were diagnosed with CL or MCL while being treated with tumor necrosis factor alpha (TNF‐α) inhibitors. Leishmaniasis presented more frequently as a plaque (58.3%) with a larger median lesion size (2.5 cm), ulceration (92.1%), and required a greater median number of intralesional meglumine antimoniate infiltrations (3 doses) (P < 0.05) than in non‐exposed patients. We found no systemic involvement in patients being treated with anti‐TNF‐α. We did not find differences regarding the treatment characteristics whether biologic therapy was modified or not. Conclusions Although management should be individualized, maintenance of biologic therapy does not seem to interfere with treatment of CL or MCL.

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Section: Discussionmentioning

confidence: 99%

Clinicopathological characteristics of cutaneous and mucocutaneous leishmaniasis in patients treated with TNF‐α inhibitors

Palacios-Diaz

Sahuquillo‐Torralba

Rocamora-Durán

et al. 2023

J Deutsche Derma Gesell

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“…This was confirmed by meta analysis of 17 studies in HIV infected individuals as the main difference among treatment regimens was in higher mortality rate with antimony use [18.4%, 95% confidence interval (CI) 13.3-25%)] 22 . Published cases of fatal toxicity related to antimonials include severe toxic hepatitis and pancreatitis 7 , fatal arrhythmia 23 , and unexpected sudden death 20 . In pediatric patients, a recent trial showed that N-methylglucamine antimoniate (n = 51) and amphotericin B deoxycholate (n = 50) had similar cure rates (94.1% vs. 94%, respectively) and serious adverse events (SAE) incidence was similar in both groups 24 .…”

Section: Discussionmentioning

confidence: 99%

“…TNF-α inhibitors are potent immunomodulator drugs with growing use in IBD. Juzlova et al 23 reported a case of 44-year-old man with Crohn's disease treated successfully with infliximab, who developed VL with cutaneous symptoms 23 . 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.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Introduction.There is a rise of visceral leishmaniasis in immunocompromised patients due to increased availability of immunomodulatory drugs. In order to point at the occurrence of visceral leishmaniasis in patients with inflammatory bowel disease (IBD), we reported a case of female patient with a travel history to European Mediterranean countries, who was on immunosuppressive treatment due to ulcerative colitis. Case report. A 29-year-old female patient was admitted to hospital due to severe relapse of ulcerative colitis. Corticosteroid therapy was administered in addition to previous longterm azathioprine, with clinical response to the treatment. During the course of the disease she had recurrent high-grade fever with marked hepatosplenomegaly and pancytopenia. The diagnosis of leishmaniasis was established by positive serology tests and microscopic finding of amastigotes in bone marrow smears. The disseminated infection was responsive to treatment with liposomal amphotericin B, but therapy had to be discontinued due to urticarial rush. Subsequent therapy with antimony was administered, but it had to be stopped too due to liver toxicity. No further treatment for leishmaniasis was initiated as the clinical and laboratory data suggested that the patient had responded to the treatment. She was discharged from hospital in IBD remission and without signs of the infection. Conclusion. Visceral leishmaniasis should be considered in IBD patients with fever of unknown origin and relevant travel history in order to achieve favorable disease outcome.Uvod. Visceralna lajšmanioza je u porastu kod imunokompromitovanih bolesnika zbog povećane dostupnosti imunomodulatornih lekova. Da bi ukazali na mogućnost postojanja visceralne lajšmanioze kod bolesnika sa zapaljenskom bolesti creva, prikazali smo bolesnicu sa ulceroznim kolitisom lečenu imunosupresivnom terapijom, koja je prethodno boravila u evropskim, mediteranskim zemljama. Prikaz bolesnika. Bolesnica, starosti 29 godina, primljena je u bolnicu sa teškim relapsom ulceroznog kolitisa. Pored dugogodišnje terapije azatioprinom primenjeno je i lečenje kortikosteroidima na koje je dobijen klinički odgovor. U toku lečenja bolesnica je bila visokofebrilna sa izraženom hepatosplenomegalijom i pancitopenijom. Dijagnoza lajšmanioze postavljena je serološkim testovima i mikroskopskim nalazom amastigota u sternalnom punktatu. Na terapiju lipozomalnim amfotericinom B dobijen je povoljan odgovor, ali je lečenje moralo biti prekinuto zbog generalizovane urtikarije. Potom je primenjeno lečenje preparatom petovalentnog antimona, ali je i ono moralo biti prekinuto zbog hepatotoksičnosti. S obzirom na to da je kod bolesnice već dobijen terapijski odgovor, dalje lečenje lajšmanioze nije primenjivano. Na otpustu iz bolnice ulcerozni kolitis je bio u remisiji i nije bilo znakova lajšmanioze. Zaključak. Kod bolesnika sa zapaljenjskom bolesti creva i febrilnošću nejasnog uzroka, koji su prethodno putovali u endemske krajeve, treba razmotriti i postojanje visceralne lajšmanioze u cilju postizanja...

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“…CL is a parasite infection caused by leishmania and transmitted by sandfly bites. Estimated incidence of CL is 0.2–0.4 million cases per year . Global burden of CL in children is likely to be underestimated as many infections are misdiagnosed or underreported.…”

Section: Discussionmentioning

confidence: 99%

An infant with a long-standing ulcer successfully treated with a novel treatment combination

et al. 2014

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Visceral leishmaniasis with cutaneous symptoms in a patient treated with infliximab followed by fatal consequences

Cited by 12 publications

References 13 publications

Clinicopathological characteristics of cutaneous and mucocutaneous leishmaniasis in patients treated with TNF‐α inhibitors

Clinicopathological characteristics of cutaneous and mucocutaneous leishmaniasis in patients treated with TNF‐α inhibitors

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

An infant with a long-standing ulcer successfully treated with a novel treatment combination

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