Case Report: Diffuse Cutaneous Leishmaniasis by Leishmania infantum in a Patient Undergoing Immunosuppressive Therapy: Risk Status in an Endemic Mediterranean Area

M. Magdalena Alcover Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain;

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Vicenç Rocamora Department of Dermatology, Hospital de Manacor, Balearic Islands, Spain;

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M. Carmen Guillén Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain;

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Diana Berenguer Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain;

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Marta Cuadrado Department of Pathology, Hospital de Manacor, Balearic Islands, Spain

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Cristina Riera Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain;

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Roser Fisa Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain;

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DOI:
https://doi.org/10.4269/ajtmh.17-0769
Volume/Issue:
Volume 98: Issue 5
Page(s):
1313–1316
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This case report highlights the risk of severe cutaneous leishmaniasis (CL) by Leishmania infantum in patients undergoing immunosuppressant therapy who either live in an endemic area or are visiting in the transmission season. The case patient, resident in Majorca (Balearic Islands), presented 12 disseminated erythematous skin lesions, 1–6 cm in diameter, located on the scalp, cheek, umbilical region, and lower extremities 8 years after undergoing anti–tumor necrosis factor (TNF) therapy. Parasite presence in peripheral blood and high levels of specific antibodies were also observed, indicating a possible risk of CL shifting toward a visceral infection. However, once CL was diagnosed, anti-TNF therapy was discontinued and liposomal amphotericin B was administered, resulting in a complete healing of lesions, no Leishmania DNA detection in blood, and an important serological decrease in antibodies. The lack of data on the supposed epidemiological association between leishmaniasis and immunosuppressive therapy highlights the importance of implementing surveillance systems in endemic areas. No obvious relationship was found based on the data provided by the Balearic Islands Epidemiological System, in contrast with data reported in nearby endemic areas. This indicates that if the suspected association is to be clarified, greater efforts are needed to report information about concomitant diseases and therapies in leishmaniasis patients.

Author Notes

Address correspondence to Roser Fisa, Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Avinguda Joan XXIII n. 27-31, E-08028, Barcelona, Catalonia, Spain. E-mail: rfisa@ub.edu

Authors’ addresses: Ma Magdalena Alcover, Ma Carmen Guillén, Diana Berenguer, Cristina Riera, and Roser Fisa, Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Barcelona, Spain, E-mails: mmagdalenaalcoveramengual@ub.edu, carmeguillen@ub.edu, berenguer.diana@gmail.com, mcriera@ub.edu, and rfisa@ub.edu. Vicenç Rocamora, Department of Dermatology, Hospital de Manacor, Balearic Islands, Spain, E-mail: vrocamora@hmanacor.org. Marta Cuadrado, Department of Pathology, Hospital de Manacor, Balearic Islands, Spain, E-mail: mcuadrado@hmanacor.org.

Reprint requests: Roser Fisa, Laboratory of Parasitology, Department of Biology, Health and Environment, Faculty of Pharmacy and Food Science, University of Barcelona, Avinguda Joan XXIII n. 27-31, E-08028, Barcelona, Catalonia, Spain, E-mail: rfisa@ub.edu, Tel: +34 934024502, Fax: +34 934024504.

Copyright:
© The American Society of Tropical Medicine and Hygiene 2018
Received:
02 Oct 2017
|
Accepted:
22 Jan 2018
|
Published Online:
26 Mar 2018
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
Online ISSN:
1476-1645
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