Visceral leishmaniasis in a patient with psoriatic arthritis treated with infliximab: reactivation of a latent infection?
Tumor necrosis factor (TNF) is a proinflammatory cytokine that plays a key role in the pathogenesis of autoimmune diseases and is an important constituent of the human immune response to infection. We report the case of a 45-year-old man with psoriatic arthritis, receiving treatment with infliximab, who presented with high-grade fever, rigor, splenomegaly, acute reactive proteins, and pancytopenia. The diagnosis of visceral leishmaniasis was established. The patient reported that his dog died from Leishmania infection 5 years ago, while he was living in an area endemic for Leishmania. The use of anti-TNF biologic agent in this patient might result in new infection or reactivation of a latent infection with Leishmania, 5 years after the exposure. A detailed current and past medical history should be obtained of every patient candidate for treatment with biologic agents, and a close monitoring is needed for serious opportunistic infections, including visceral leishmaniasis.
Tektonidou
Maria G
MG
Department of Internal Medicine, Euroclinic Hospital of Athens, 9 Athanasiadou str, Athens, Greece. mtektonidou@euroclinic.gr
Skopouli
Fotini N
FN
D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D000069285:Infliximab; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000209:etiology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab