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Am. J. Trop. Med. Hyg., 81(1), 2009, pp. 52-54
Copyright © 2009 by The American Society of Tropical Medicine and Hygiene

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CASE REPORT


Relapsing Cutaneous Leishmaniasis in a Patient with Ankylosing Spondylitis Treated with Infliximab

Matthias C. Mueller*, Erna Fleischmann, Mathias Grunke, Stefan Schewe, Johannes R. Bogner, AND Thomas Löscher
Medizinische Poliklinik, Divison of Infectious Diseases, University of Munich, Munich, Germany; Medizinische Poliklinik, Division of Rheumatology, University of Munich, Munich, Germany; Department of Infectious Diseases and Tropical Medicine, University of Munich, Munich, Germany

 

ABSTRACT

A 31-year-old man with ankylosing spondylitis, receiving treatment with infliximab, presented with a large progressive cutaneous ulcer at the right knee. Biopsies showed Leishmania amastigotes, and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis showed Leishmania infantum as the causative agent. After treatment with miltefosine, the ulcer resolved completely, and infliximab was reinstituted because of progression of spondylitis. After 1 year, there was a recurrent ulcer at the same site being positive for Leishmania DNA by PCR. Local treatment with sodium stibogluconate resulted in complete regression. Cutaneous leishmaniasis should be added to the list of opportunistic infections associated with anti-tumor necrosis factor (TNF) treatment. Despite recurrences, antileish-manial treatment may be effective in cases without alternatives to anti-TNF therapy.

Received January 16, 2009. Accepted for publication March 27, 2009.

Acknowledgments: The authors thank Dr. Francine Pratlong and Professor Jean-Pierre Dedet, Laboratoire de Parasitologie and Centre National de Référence des Leishmania, Centre Hospitalier Universitaire de Montpellier, for the zymodeme determination by multilocus isoenzyme analysis.

Disclaimers: Dr. Grunke has received consulting fees from Centocor. There are no conflicts of interests for the other authors.

* Address correspondence to Matthias C. Mueller, Division of Infectious Diseases, Medizinische Poliklinik, University Hospital of Munich, Pettenkoferstr. 8a, 80336 Munich, Germany. E-mail: matthias.mueller{at}med.uni-muenchen.de

Authors’ addresses: Matthias Müller, Division of Infectious Diseases, Medizinische Poliklinik, University Hospital of Munich Pettenkoferstr. 8a, 80336 Munich, Germany, Tel: 49/89-5160-3550, Fax: 49/89-5160-3593, E-mail: matthias.mueller{at}med.uni-muenchen.de. Erna Fleischmann, Department of Infectious Diseases and Tropical Medicine Munich, Leopoldstrasse 5, 80802 Munich, Germany, E-mail: fleischmann{at}lrz.uni-muenchen.de. Mathias Grünke, Division of Rheumatology, Medizinische Poliklinik–Innenstadt, University Hospital of Munich, Pettenkoferstr. 8a, 80336 Munich, Germany, E-mail: Mathias.Gruenke{at}med.uni-muenchen.de. Stefan Schewe, Division of Rheumatology, Medizinische Poliklinik–Innenstadt, University Hospital of Munich, Pettenkoferstr. 8a, 80336 Munich, Germany, E-mail: Stefan.Schewe{at}med.uni-muenchen.de. Johannes Bogner, Division of Infectious Diseases, Medizinische Poliklinik, University Hospital of Munich, Pettenkoferstr. 8a, 80336 Munich, Germany, Tel: 49/89-5160-3550, Fax: 49/89-5160-3593, E-mail: Johannes.Bogner{at}med.uni-muenchen.de. Thomas Löscher, Department of Infectious Diseases and Tropical Medicine Munich, Leopoldstrasse 5, 80802 Munich, Germany, E-mail: Loescher{at}lrz.uni-muenchen.de.

Reprint requests: Matthias Müller, Division of Infectious Diseases, Medizinische Poliklinik, University Hospital of Munich, Pettenkoferstr. 8a, 80336 Munich, Germany, Tel: +49/89-5160-3550, Fax: 49/89-5160-3593, E-mail: matthias.mueller{at}med.uni-muenchen.de.






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