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Secondary Prophylaxis with Liposomal Amphotericin B in a Patient with Mucosal Leishmaniasis Undergoing Immunobiological Therapy for Active Ankylosing Spondylitis
Immunosuppressive treatments for rheumatic diseases present special problems in areas endemic for chronic infectious diseases because of the possibility of reactivation. Leishmaniasis is a significant neglected tropical disease caused by different species of protozoan parasites within the genus Leishmania. Amastigotes live as intracellular parasites in a variety of mammalian cells, most notably within phagocytes such as macrophages, and residual parasites can persist even after treatment and healing of the lesions. We herein report a case of relapsing mucosal leishmaniasis after aggressive immunotherapy for ankylosing spondylitis, with requirement for secondary prophylaxis with amphotericin B to prevent reactivation. This approach can be necessary for patients from endemic areas of tegumentary leishmaniasis, who will undergo aggressive immunotherapy.
Author Notes
Authors’ addresses: Antonio Carlos Nicodemo and Valdir Sabbaga Amato, Department of Infectious Diseases, University of São Paulo Medical School, Sao Paulo, Brazil, E-mails: ac_nicodemo@uol.com.br and valdirsa@netpoint.com.br. Heitor Franco de Andrade Jr., Department of Pathology, University of São Paulo Medical School, Sao Paulo, Brazil, E-mail: hfandrad@usp.br. Pablo Muñoz Torres, Department of Infectious and Parasitic Diseases, Clinical Hospital, University of São Paulo Medical School, Sao Paulo, Brazil, E-mail: pamt90.nap@gmail.com.