Reactivation of cutaneous and mucocutaneous tegumentary leishmaniasis in rheumatoid arthritis patients: an emerging problem?

Rev Inst Med Trop Sao Paulo

Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil.

Published: April 2017

AI Article Synopsis

  • Rheumatoid arthritis (RA) is a chronic disease that commonly affects people in tropical regions where leishmaniasis is prevalent, and is often treated with immunosuppressive drugs like methotrexate and prednisone.
  • A report highlights two unusual cases of leishmaniasis in RA patients: one with a cutaneous ulcer misdiagnosed initially, and another with painful nodules, both confirmed to have Leishmania DNA.
  • After treatment with liposomal amphotericin, both patients healed, leading to the recommendation that immunosuppressive therapies for RA should be used cautiously in patients from endemic areas or with a history of leishmaniasis.

Article Abstract

Rheumatoid arthritis (RA) is a chronic condition that is frequent in patients living in tropical areas exposed to leishmaniasis. RA therapy involves immunosuppressant drugs such as methotrexate (MTX), monoclonal antibodies (mAbs) and prednisone. We report an unusual presentation of cutaneous (CL) or mucocutaneous leishmaniasis (ML) in RA patients from an endemic area of leishmaniasis. A 51-year-old woman noted a cutaneous ulcer on her left ankle during MTX and prednisone RA therapy. Initially diagnosed as a venous stasis ulcer, the aspirate of the injury revealed the presence of Leishmania DNA. A 73-year-old woman presenting non-ulcerated, infiltrated and painful erythematous nodules inside her nostrils while receiving MTX, anti-TNF mAb, and prednisone for RA, had also the aspirate of injuries showing the presence of Leishmania DNA. Both patients healed after the therapy with liposomal amphotericin. The RA therapy has changed to low-dose prednisone, without further reactivation episodes. Both cases suggest that CL or ML can reactivate after administration of an immunosuppressant for RA treatment. Therefore, immunosuppressive treatments for RA should be carefully prescribed in patients from endemic areas or with a history of CL and ML.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5441157PMC
http://dx.doi.org/10.1590/S1678-9946201759006DOI Listing

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