Complicated Cutaneous Leishmaniasis in a Patient under Combined Immunosuppression
DOI:
https://doi.org/10.20344/amp.19446Keywords:
Immunosuppression Therapy, Leishmaniasis, Cutaneous, Neglected DiseasesAbstract
Species associated with visceral leishmaniasis, such as L. infantum, may be responsible for cutaneous leishmaniasis (CL), particularly in the Mediterranean region. In immunosuppressed hosts, classification as complicated CL is essential, as the risk of mucosal leishmaniasis warrants systemic therapy. We report the case of a forty-seven-year-old male living in Portugal, with Fabry disease and receiving immunosuppressive treatment with adalimumab and methotrexate for Crohn’s disease. There was no travel history outside of Europe. He presented a two-year-old, 5.5 cm plaque with a well-defined hyperkeratotic elevated border and central, painless ulceration on his back. The biopsy revealed parasites inside macrophages suggestive of Leishmania, and PCR identified the species as L. infantum. A biopsy via nasal endoscopy excluded mucosal involvement. Classification as complicated CL dictated treatment with liposomal amphotericin B and subsequent topical paramomycin. The rarity of CL in Portugal may delay its diagnosis, especially in autochthonous infections. Treatment choice is complicated by the heterogeneity of drugs available worldwide. As the global prevalence of CL increases, it is important to be aware of this diagnosis.
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Aronson NH, Libman M, Pearson R, Lopez-Velez R, Weina P, Carvalho EM, et al. Diagnosis and treatment of leishmaniasis: clinical practice guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis. 2016;63:e202. DOI: https://doi.org/10.1093/cid/ciw670
Aronson N. Cutaneous leishmaniasis: epidemiology and control. [cited 2022 Nov 30]. Available from: https://www.uptodate.com/contents/cutaneousleishmaniasis-epidemiology-and-control.
Campino L, Abranches P. Cutaneous leishmaniasis. Unusual disease in Portugal? Acta Med Port. 2002;15:387-90.
van Griensven J, Carrillo E, López-Vélez R, Lynen L, Moreno J. Leishmaniasis in immunosuppressed individuals. Clin Microbiol Infect. 2014;20:286. DOI: https://doi.org/10.1111/1469-0691.12556
Aronson N. Cutaneous leishmaniasis: clinical manifestations and diagnosis. [cited 2022 Nov 30]. Available from: https://www.uptodate.com/contents/cutaneous-leishmaniasis-clinical-manifestations-and-diagnosis.
Aronson N. Cutaneous leishmaniasis: treatment. [cited 2022 Nov 30]. Available from: https://www.uptodate.com/contents/cutaneous-leishmaniasistreatment.
Solomon M, Sahar N, Pavlotzky F, Barzilai A, Jaffe CL, Nasereddin A, et al. Mucosal leishmaniasis in travelers with leishmania braziliensis complex returning to Israel. Emerg Infect Dis. 2019;25:642. DOI: https://doi.org/10.3201/eid2504.180239
Heras-Mosteiro J, Monge-Maillo B, Pinart M, Lopez Pereira P, Reveiz L, Garcia-Carrasco E, et al. Interventions for old world cutaneous leishmaniasis. Cochrane Database Syst Rev. 2017;12:CD005067. DOI: https://doi.org/10.1002/14651858.CD005067.pub5
Mendonça MG, de Brito M, Rodrigues EH, Bandeira V, Jardim ML, Abath FG. Persistence of leishmania parasites in scars after clinical cure of American cutaneous leishmaniasis: is there a sterile cure? J Infect Dis. 2004;189:1018. DOI: https://doi.org/10.1086/382135
Guery R, Benoit H, Martin-Blondel G, Rouzaud C, Cordoliani F, Harms G, et al. Liposomal amphotericin B in travelers with cutaneous and mucocutaneous leishmaniasis: not a panacea. PLoS Negl Trop Dis. 2017;11:e0006094. DOI: https://doi.org/10.1371/journal.pntd.0006094
Hellier I, Dereure O, Tournillac I, Pratlong F, Guillot B, Dedet JP, et al. Treatment of old world cutaneous leishmaniasis by pentamidine isethionate. An open study of 11 patients. Dermatology. 2000;200:120-3. DOI: https://doi.org/10.1159/000018343
Dorlo TP, van Thiel P, Schoone GJ, Stienstra Y, van Vugt M, Beijnen JH, et al. Dynamics of parasite clearance in cutaneous leishmaniasis patients treated with miltefosine. PLoS Negl Trop Dis. 2011;5:e1436. DOI: https://doi.org/10.1371/journal.pntd.0001436
Paniz Mondolfi AE, Stavropoulos C, Gelanew T, Loucas E, Perez Alvarez AM, Benaim G, et al. Successful treatment of old world cutaneous leishmaniasis caused by Leishmania infantum with posaconazole. Antimicrob Agents Chemother. 2011;55:1774. DOI: https://doi.org/10.1128/AAC.01498-10
Kim DH, Chung HJ, Bleys J, Ghohestani RF. Is paromomycin an effective and safe treatment against cutaneous leishmaniasis? A meta-analysis of 14 randomized controlled trials. PLoS Negl Trop Dis. 2009;3:e381. DOI: https://doi.org/10.1371/journal.pntd.0000381
Brito NC, Rabello A, Cota GF. Efficacy of pentavalent antimoniate intralesional infiltration therapy for cutaneous leishmaniasis: a systematic review. PLoS One. 2017;12:e0184777. DOI: https://doi.org/10.1371/journal.pone.0184777
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