Complicated Cutaneous Leishmaniasis in a Patient under Combined Immunosuppression
Species associated with visceral leishmaniasis, such as L. infantum, may be responsible for cutaneous leishmaniasis (CL), particularly in the Mediterranean region. In immunosuppressed hosts, classification as complicated CL is essential, as the risk of mucosal leishmaniasis warrants systemic therap...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Ordem dos Médicos
2023-10-01
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| Series: | Acta Médica Portuguesa |
| Subjects: | |
| Online Access: | http://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/19446 |
| _version_ | 1797660256232275968 |
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| author | António Carujo Joel Reis André Santos Silva Miguel Araújo Abreu António Ludgero Vasconcelos |
| author_facet | António Carujo Joel Reis André Santos Silva Miguel Araújo Abreu António Ludgero Vasconcelos |
| author_sort | António Carujo |
| collection | DOAJ |
| description |
Species associated with visceral leishmaniasis, such as L. infantum, may be responsible for cutaneous leishmaniasis (CL), particularly in the Mediterranean region. In immunosuppressed hosts, classification as complicated CL is essential, as the risk of mucosal leishmaniasis warrants systemic therapy. We report the case of a forty-seven-year-old male living in Portugal, with Fabry disease and receiving immunosuppressive treatment with adalimumab and methotrexate for Crohn’s disease. There was no travel history outside of Europe. He presented a two-year-old, 5.5 cm plaque with a well-defined hyperkeratotic elevated border and central, painless ulceration on his back. The biopsy revealed parasites inside macrophages suggestive of Leishmania, and PCR identified the species as L. infantum. A biopsy via nasal endoscopy excluded mucosal involvement. Classification as complicated CL dictated treatment with liposomal amphotericin B and subsequent topical paramomycin. The rarity of CL in Portugal may delay its diagnosis, especially in autochthonous infections. Treatment choice is complicated by the heterogeneity of drugs available worldwide. As the global prevalence of CL increases, it is important to be aware of this diagnosis.
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| first_indexed | 2024-03-11T18:28:09Z |
| format | Article |
| id | doaj.art-a0acb3f252f142bcaaf635081a9c43c2 |
| institution | Directory Open Access Journal |
| issn | 0870-399X 1646-0758 |
| language | English |
| last_indexed | 2024-03-11T18:28:09Z |
| publishDate | 2023-10-01 |
| publisher | Ordem dos Médicos |
| record_format | Article |
| series | Acta Médica Portuguesa |
| spelling | doaj.art-a0acb3f252f142bcaaf635081a9c43c22023-10-13T14:28:52ZengOrdem dos MédicosActa Médica Portuguesa0870-399X1646-07582023-10-0110.20344/amp.19446Complicated Cutaneous Leishmaniasis in a Patient under Combined ImmunosuppressionAntónio Carujo0Joel Reis1André Santos Silva2Miguel Araújo Abreu3António Ludgero Vasconcelos4Serviço de Doenças Infeciosas. Centro Hospitalar Universitário do Porto. Porto.Serviço de Dermatologia. Centro Hospitalar Universitário do Porto. Porto. Serviço de Doenças Infeciosas. Centro Hospitalar Universitário do Porto. Porto; Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto.Serviço de Doenças Infeciosas. Centro Hospitalar Universitário do Porto. Porto; Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto.Serviço de Doenças Infeciosas. Centro Hospitalar Universitário do Porto. Porto; Instituto de Ciências Biomédicas Abel Salazar. Universidade do Porto. Porto. Species associated with visceral leishmaniasis, such as L. infantum, may be responsible for cutaneous leishmaniasis (CL), particularly in the Mediterranean region. In immunosuppressed hosts, classification as complicated CL is essential, as the risk of mucosal leishmaniasis warrants systemic therapy. We report the case of a forty-seven-year-old male living in Portugal, with Fabry disease and receiving immunosuppressive treatment with adalimumab and methotrexate for Crohn’s disease. There was no travel history outside of Europe. He presented a two-year-old, 5.5 cm plaque with a well-defined hyperkeratotic elevated border and central, painless ulceration on his back. The biopsy revealed parasites inside macrophages suggestive of Leishmania, and PCR identified the species as L. infantum. A biopsy via nasal endoscopy excluded mucosal involvement. Classification as complicated CL dictated treatment with liposomal amphotericin B and subsequent topical paramomycin. The rarity of CL in Portugal may delay its diagnosis, especially in autochthonous infections. Treatment choice is complicated by the heterogeneity of drugs available worldwide. As the global prevalence of CL increases, it is important to be aware of this diagnosis. http://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/19446Immunosuppression TherapyLeishmaniasis, CutaneousNeglected Diseases |
| spellingShingle | António Carujo Joel Reis André Santos Silva Miguel Araújo Abreu António Ludgero Vasconcelos Complicated Cutaneous Leishmaniasis in a Patient under Combined Immunosuppression Acta Médica Portuguesa Immunosuppression Therapy Leishmaniasis, Cutaneous Neglected Diseases |
| title | Complicated Cutaneous Leishmaniasis in a Patient under Combined Immunosuppression |
| title_full | Complicated Cutaneous Leishmaniasis in a Patient under Combined Immunosuppression |
| title_fullStr | Complicated Cutaneous Leishmaniasis in a Patient under Combined Immunosuppression |
| title_full_unstemmed | Complicated Cutaneous Leishmaniasis in a Patient under Combined Immunosuppression |
| title_short | Complicated Cutaneous Leishmaniasis in a Patient under Combined Immunosuppression |
| title_sort | complicated cutaneous leishmaniasis in a patient under combined immunosuppression |
| topic | Immunosuppression Therapy Leishmaniasis, Cutaneous Neglected Diseases |
| url | http://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/19446 |
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