Relapsing cutaneous leishmaniasis in a patient with ankylosing spondylitis treated with infliximab.
A 31-year-old man with ankylosing spondylitis, receiving treatment with infliximab, presented with a large progressive cutaneous ulcer at the right knee. Biopsies showed Leishmania amastigotes, and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis showed Leishmania infantum as the causative agent. After treatment with miltefosine, the ulcer resolved completely, and infliximab was reinstituted because of progression of spondylitis. After 1 year, there was a recurrent ulcer at the same site being positive for Leishmania DNA by PCR. Local treatment with sodium stibogluconate resulted in complete regression. Cutaneous leishmaniasis should be added to the list of opportunistic infections associated with anti-tumor necrosis factor (TNF) treatment. Despite recurrences, antileish-manial treatment may be effective in cases without alternatives to anti-TNF therapy.
Mueller
Matthias C
MC
Medizinische Poliklinik, Divison of Infectious Diseases, University of Munich, Munich, Germany. matthias.mueller@med.uni-muenchen.de
Fleischmann
Erna
E
Grunke
Mathias
M
Schewe
Stefan
S
Bogner
Johannes R
JR
Löscher
Thomas
T
D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D006801:Humans; D000069285:Infliximab; D016773:Leishmaniasis, Cutaneous / Q000209:etiology*; D008297:Male; D052247:Nitric Oxide Synthase Type II / Q000502:physiology; D012008:Recurrence; D013167:Spondylitis, Ankylosing / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
D000911:Antibodies, Monoclonal; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D052247:Nitric Oxide Synthase Type II