Complicated Cutaneous Leishmaniasis in a Patient under Combined Immunosuppression

Authors

  • António Carujo Serviço de Doenças Infeciosas. Centro Hospitalar Universitário do Porto. Porto.
  • Joel Reis Serviço de Dermatologia. Centro Hospitalar Universitário do Porto. Porto.
  • André Santos Silva Serviço de Doenças Infeciosas. Centro Hospitalar Universitário do Porto. Porto; Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto.
  • Miguel Araújo Abreu Serviço de Doenças Infeciosas. Centro Hospitalar Universitário do Porto. Porto; Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto.
  • António Ludgero Vasconcelos Serviço de Doenças Infeciosas. Centro Hospitalar Universitário do Porto. Porto; Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto.

DOI:

https://doi.org/10.20344/amp.19446

Keywords:

Immunosuppression Therapy, Leishmaniasis, Cutaneous, Neglected Diseases

Abstract

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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References

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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Published

2023-10-13

How to Cite

1.
Carujo A, Reis J, Santos Silva A, Araújo Abreu M, Ludgero Vasconcelos A. Complicated Cutaneous Leishmaniasis in a Patient under Combined Immunosuppression. Acta Med Port [Internet]. 2023 Oct. 13 [cited 2024 May 28];36(12):841-5. Available from: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/19446

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Section

Case Report