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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.
Authors’ addresses: Antonio Carlos Nicodemo and Valdir Sabbaga Amato, Department of Infectious Diseases, University of São Paulo Medical School, Sao Paulo, Brazil, E-mails: firstname.lastname@example.org and email@example.com. Heitor Franco de Andrade Jr., Department of Pathology, University of São Paulo Medical School, Sao Paulo, Brazil, E-mail: firstname.lastname@example.org. Pablo Muñoz Torres, Department of Infectious and Parasitic Diseases, Clinical Hospital, University of São Paulo Medical School, Sao Paulo, Brazil, E-mail: email@example.com.