title: Secondary leprosy infection in a patient with psoriasis during treatment with infliximab.
abstract: Tumor necrosis factor α antagonists are proven to be effective for the treatment of chronic inflammatory conditions, such as psoriasis. A major concern for patients is the risk of acquiring granulomatous infectious diseases caused by the immunosuppressive effects of the drugs. We report a 60-year-old man with psoriasis who underwent infliximab treatment for 2 years and developed secondary leprosy, presenting extensive erythematous and infiltrated plaques on the trunk and limbs with loss of sensitivity (thermal, pain and tactile). The skin lesion biopsy showed perivascular epithelioid granulomas, nodular dermal aggregates of foamy macrophages and bundles of acid-fast bacilli. The clinical picture associated with histopathologic evaluation suggested borderline lepromatous leprosy. Before infliximab treatment, the patient had a positive tuberculin skin test and underwent chemoprophylaxis treatment for latent tuberculosis. Although the tuberculin reactivity suggests a strong correlation with a latent Mycobacterium tuberculosis infection, the possibility of infections by other mycobacteria, such as Mycobacterium leprae, should not be discarded.
authors.affiliation: Posgraduation Program of Biotechnology (RENORBIO), Hospital Universitário Walter Cantídio, Universidade Federal do Ceara, Fortaleza, Ceara, Brazil. briciamt@yahoo.com.br
authors.forename: Fabricia Martins
authors.initials: FM
authors.lastname: Teixeira
authors.forename: Luciana Mabel Ferreira
authors.initials: LM
authors.lastname: Vasconcelos
authors.forename: Clarissa de Alencar Diogenes
authors.initials: Cde A
authors.lastname: Rola
authors.forename: Thereza Lúcia
authors.initials: TL
authors.lastname: Prata de Almeida
authors.forename: José Telmo
authors.initials: JT
authors.lastname: Valença
authors.forename: Aparecida Tiemi
authors.initials: AT
authors.lastname: Nagao-Dias
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use*; D000995:Antitubercular Agents / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D000069285:Infliximab; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000188:drug therapy; D007917:Leprostatic Agents / Q000627:therapeutic use; D015439:Leprosy, Borderline / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009166:Mycobacterium leprae; D009169:Mycobacterium tuberculosis; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D011565:Psoriasis / Q000188:drug therapy*; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D000995:Antitubercular Agents; D007166:Immunosuppressive Agents; D007917:Leprostatic Agents; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab