title: Reactivation of mucosal and cutaneous leishmaniasis in a renal transplanted patient.
abstract: Mucosal leishmaniasis (ML) is a chronic form of tegumentary leishmaniasis, which causes destructive lesions of nasal, pharyngeal, and laryngeal mucosa. We describe a case of leishmaniasis reactivation with simultaneous cutaneous and mucosal forms in a renal transplanted patient with no history of prior leishmaniasis. Reactivation after renal transplantation was not reported in Brazil. A 67-year-old woman receiving prednisone 20 mg/day, tacrolimus 1 mg/day, and mycophenolic acid 360 mg/day presented with nose edema with erythema and cutaneous lesions. Amastigotes were identified on biopsies and the polymerase chain reaction confirmed Leishmania (Viannia) braziliensis. The patient was treated with liposomal amphotericin B but died 3 weeks after as a result of bacterial septic shock. In conclusion, tegumentary leishmaniasis can reactivate with simultaneous cutaneous and mucosal forms in a renal transplanted patient during the immunosuppressant therapy.
authors.affiliation: Division of Infectious Diseases, Universidade Federal do Parana, Curitiba, PR, Brazil; Division of Infectious and Parasitic Diseases, Hospital Universitário Evangélico de Curitiba, Curitiba, PR, Brazil; Department of Infectious Diseases, University of São Paulo, Medical School, São Paulo, Brazil; Parasitology Laboratory Medical Research, Clinical Hospital, University of São Paulo, Medical School, São Paulo, Brazil flptuon@gmail.com.
authors.forename: Felipe F
authors.initials: FF
authors.lastname: Tuon
authors.affiliation: Division of Infectious Diseases, Universidade Federal do Parana, Curitiba, PR, Brazil; Division of Infectious and Parasitic Diseases, Hospital Universitário Evangélico de Curitiba, Curitiba, PR, Brazil; Department of Infectious Diseases, University of São Paulo, Medical School, São Paulo, Brazil; Parasitology Laboratory Medical Research, Clinical Hospital, University of São Paulo, Medical School, São Paulo, Brazil.
authors.forename: Giovana Marina
authors.initials: GM
authors.lastname: Bombonatto
authors.affiliation: Division of Infectious Diseases, Universidade Federal do Parana, Curitiba, PR, Brazil; Division of Infectious and Parasitic Diseases, Hospital Universitário Evangélico de Curitiba, Curitiba, PR, Brazil; Department of Infectious Diseases, University of São Paulo, Medical School, São Paulo, Brazil; Parasitology Laboratory Medical Research, Clinical Hospital, University of São Paulo, Medical School, São Paulo, Brazil.
authors.forename: Eveline Roesler
authors.initials: ER
authors.lastname: Battaglin
authors.affiliation: Division of Infectious Diseases, Universidade Federal do Parana, Curitiba, PR, Brazil; Division of Infectious and Parasitic Diseases, Hospital Universitário Evangélico de Curitiba, Curitiba, PR, Brazil; Department of Infectious Diseases, University of São Paulo, Medical School, São Paulo, Brazil; Parasitology Laboratory Medical Research, Clinical Hospital, University of São Paulo, Medical School, São Paulo, Brazil.
authors.forename: Marcus Henrique
authors.initials: MH
authors.lastname: Sakumoto
authors.affiliation: Division of Infectious Diseases, Universidade Federal do Parana, Curitiba, PR, Brazil; Division of Infectious and Parasitic Diseases, Hospital Universitário Evangélico de Curitiba, Curitiba, PR, Brazil; Department of Infectious Diseases, University of São Paulo, Medical School, São Paulo, Brazil; Parasitology Laboratory Medical Research, Clinical Hospital, University of São Paulo, Medical School, São Paulo, Brazil.
authors.forename: Valdir Sabbaga
authors.initials: VS
authors.lastname: Amato
authors.affiliation: Division of Infectious Diseases, Universidade Federal do Parana, Curitiba, PR, Brazil; Division of Infectious and Parasitic Diseases, Hospital Universitário Evangélico de Curitiba, Curitiba, PR, Brazil; Department of Infectious Diseases, University of São Paulo, Medical School, São Paulo, Brazil; Parasitology Laboratory Medical Research, Clinical Hospital, University of São Paulo, Medical School, São Paulo, Brazil.
authors.forename: Raphael Abegão
authors.initials: RA
authors.lastname: de Camargo
authors.affiliation: Division of Infectious Diseases, Universidade Federal do Parana, Curitiba, PR, Brazil; Division of Infectious and Parasitic Diseases, Hospital Universitário Evangélico de Curitiba, Curitiba, PR, Brazil; Department of Infectious Diseases, University of São Paulo, Medical School, São Paulo, Brazil; Parasitology Laboratory Medical Research, Clinical Hospital, University of São Paulo, Medical School, São Paulo, Brazil.
authors.forename: Antônio Carlos
authors.initials: AC
authors.lastname: Nicodemo
mesh_terms: D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation; D007892:Leishmania braziliensis / Q000187:drug effects / Q000472:pathogenicity / Q000502:physiology*; D007897:Leishmaniasis, Mucocutaneous / Q000188:drug therapy / Q000209:etiology*; D017211:Treatment Failure
chemical_list: D000981:Antiprotozoal Agents; D007166:Immunosuppressive Agents; D000666:Amphotericin B
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