title: Cutaneous leishmaniasis with histopathologic pattern of non-necrotizing granulomatous dermatitis in patients treated with adalimumab.
abstract: Human leishmaniasis produced by Leishmania infantum is endemic in Mediterranean countries. In the context of a leishmaniasis outbreak in the town of Fuenlabrada, Madrid, Spain, we had two patients with cutaneous leishmaniasis that developed non-necrotizing cutaneous granulomas. They had both been receiving anti-TNF treatment with adalimumab for rheumatic diseases. Neither of them developed visceral disease and did not require anti-TNF treatment withdrawal to control the cutaneous disease. It is well known that anti-TNF therapy is associated with opportunistic diseases, especially with those in which granuloma formation is an important part of the host defence, as in tuberculosis. We think that granuloma formation through activation of Toll-like receptor-9 and via induction of a Th17 response may be precipitated by the parasites in the dermis.
authors.affiliation: Department of Dermatology, Hospital Universitario de Fuenlabrada, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Romero-Maté
authors.forename: Diego
authors.initials: D
authors.lastname: Martínez-Sánchez
authors.forename: Juan C
authors.initials: JC
authors.lastname: Tardío
authors.forename: Amalia
authors.initials: A
authors.lastname: Moreno-Torres
authors.forename: Carmen
authors.initials: C
authors.lastname: García-Donoso
authors.forename: Marta
authors.initials: M
authors.lastname: Aguado-Lobo
authors.forename: Pablo
authors.initials: P
authors.lastname: Espinosa-Lara
authors.forename: Jesús
authors.initials: J
authors.lastname: Borbujo
mesh_terms: D000068879:Adalimumab; D000974:Antibodies, Antinuclear / Q000097:blood; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D015535:Arthritis, Psoriatic / Q000188:drug therapy*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006099:Granuloma / Q000209:etiology* / Q000473:pathology*; D006801:Humans; D016773:Leishmaniasis, Cutaneous / Q000209:etiology* / Q000473:pathology*; D008536:Meglumine / Q000627:therapeutic use; D000077485:Meglumine Antimoniate; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009942:Organometallic Compounds / Q000627:therapeutic use
chemical_list: D000974:Antibodies, Antinuclear; D061067:Antibodies, Monoclonal, Humanized; D009942:Organometallic Compounds; D008536:Meglumine; D000077485:Meglumine Antimoniate; D000068879:Adalimumab; D008727:Methotrexate