title: An atypical presentation of visceral leishmaniasis infection in a patient with rheumatoid arthritis treated with infliximab.
abstract: Tumor necrosis factor alpha (TNF-alpha) is a cytokine, implicated in the pathogenesis of many inflammatory diseases, as well as in the immune-mediated response to infection, especially against intracellular pathogens. TNF-alpha antagonists have represented a revolution in the management of connective tissue diseases, such as rheumatoid arthritis. However, the use of these agents has been implicated with the emergence of a growing number of opportunistic infections. Here we report the case of a visceral Leishmaniasis in a 77-year-old woman who had been previously treated for rheumatoid arthritis with infliximab. The atypical presentation of this patient, previously treated with an anti-TNF-alpha biologic agent, where no splenomegaly or hepatomegaly was identified, is emphasized.
authors.affiliation: 1st Department of Internal Medicine, Evangelismos Hospital, Athens, Greece. konstantinoskritikos@yahoo.com
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Kritikos
authors.forename: Evangelos
authors.initials: E
authors.lastname: Haritatos
authors.forename: Stelios
authors.initials: S
authors.lastname: Tsigkos
authors.forename: Panagiota
authors.initials: P
authors.lastname: Gounari
authors.forename: Ioanna
authors.initials: I
authors.lastname: Skrapari
authors.forename: Theodore
authors.initials: T
authors.lastname: Gounaris
authors.forename: Evangelia
authors.initials: E
authors.lastname: Sioula
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D001856:Bone Marrow Examination; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D000069285:Infliximab; D007898:Leishmaniasis, Visceral / Q000175:diagnosis* / Q000276:immunology*; D007970:Leukopenia / Q000209:etiology
chemical_list: D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab