Background Leishmaniasis is a chronic protozoal disease endemic in several areas of the world. In the Mediterranean basin cutaneous leishmaniasis is caused by Leishmania infantum and usually produces localized skin lesions. Biological therapy (BT) may increase the risk of reactivation or development of infections such as tuberculosis, mycoses and protozoan diseases. However, there is scarce literature on Leishmania infections in patients treated with anti-TNF drugs. We have diagnosed five cases of cutaneous leishmaniasis in patients treated with anti-TNF drugs in the last four years.
Objectives To show the clinical characteristics and the evolution of cutaneous leishmaniasis in patients treated with BT at a tertiary level hospital.
Methods We reviewed the clinical characteristics, previous treatments, the complementary tests used for the diagnosis, the main disease, the therapy used for the treatment of the infection, the clinical evolution and the reintroduction of the BT.
Results In the last four years we have diagnosed five cases of cutaneous leishmaniasis in patients treated with BT. Four of them were men and one a woman, the age range was 35 to 61 years old. In four of them the symptoms were only cutaneous, but one of them also had systemic impairment, basically hepatosplenomegaly. For the diagnosis skin biopsy, positive PCR for Leishmania DNA from skin samples, serology and response to treatment were all needed. Three cases were patients treated with adalimumab and two treated with infliximab. Three patients had Crohn's disease, one psoriatic arthritis and the other ankylosing spondylitis. The diagnostic delay was between 5 and 24 months. All patients were treated with EV liposomal amphotericin B, and two of them also received intralesional injections of meglumine antimoniate. In all cases resolution was achieved, and there have been no relapses to date after reintroduction of BT.
Conclusions We have to consider cutaneous leishmaniasis in patients with BT who present compatible skin lesions, especially in endemic areas. It is important to be aware of this type of condition in order to make a fast and accurate diagnosis.
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Disclosure of Interest None declared