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

Authors

  • Regina Maia de Souza Universidade de São Paulo; Instituto de Medicina Tropical de São Paulo; Laboratório de Parasitologia
  • Heitor Franco de Andrade Junior Universidade de São Paulo; Instituto de Medicina Tropical de São Paulo; Laboratório de Protozoologia
  • Maria Irma Seixas Duarte Universidade de São Paulo; Faculdade de Medicina; Departamento de Patologia
  • Lucia Maria Almeida Braz Universidade de São Paulo; Instituto de Medicina Tropical de São Paulo; Laboratório de Parasitologia
  • Armando de Oliveira Schubach Fundação Oswaldo Cruz; Instituto Nacional de Infectologia Evandro Chagas; Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses
  • Fátima Conceição Silva Instituto Oswaldo Cruz; Laboratório de Imunoparasitologia
  • Valdir Sabbaga Amato Universidade de São Paulo; Instituto de Medicina Tropical de São Paulo; Laboratório de Parasitologia

Keywords:

Leishmaniasis, Reactivation, Methotrexate, Anti-TNF mabs, Rheumatoid arthritis

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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Published

2017-01-01

Issue

Section

Case Report

How to Cite

Reactivation of cutaneous and mucocutaneous tegumentary leishmaniasis in rheumatoid arthritis patients: an emerging problem?. (2017). Revista Do Instituto De Medicina Tropical De São Paulo, 59, e6. https://revistas.usp.br/rimtsp/article/view/130564