Visceral leishmaniasis and anti-TNF-alpha therapy: case report and review of the literature.
OBJECTIVE
Visceral leishmaniasis (VL) is an extremely rare example of opportunistic infection in patients treated with TNF-alpha antagonists and only a few cases have been described. In this paper risk factors, clinical features, diagnostic work-up and outcome of patients developing VL under biologic therapy are described.


METHODS
Case report and review of the published cases of VL in patients under biologic treatment.


RESULTS
We retrieved six patients, including ours, all of whom presented anarchic fever and pancytopenia. In 5 cases, splenomegaly was detected. The same number of patients came from endemic areas for VL. In the majority of the cases a bone marrow examination was not diagnostic, requiring the performance of a second one and/or the execution of other diagnostic tests. One fatal outcome was observed.


CONCLUSIONS
Even if VL represents a sporadic complication of biologic treatments, its presence should always be suspected in patients developing a triad of signs and symptoms constituted by fluctuant fever, pancytopenia and splenomegaly, especially if coming from endemic areas. In these cases an extensive diagnostic work-up must be warranted. Atypical and confusing features may resemble autoimmune diseases at presentation and during the course of the illness.
De Leonardis
F
F
Section of Rheumatology, Department of Clinical and Experimental Medicine, University of Ferrara, 44100, Ferrara, Italy. dlnfnc@unife.it
Govoni
M
M
Lo Monaco
A
A
Trotta
F
F
D000818:Animals; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D006801:Humans; D000069285:Infliximab; D007893:Leishmania donovani; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis* / Q000503:physiopathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000502:physiology
D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab