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Case Report: Leishmaniasis in a 33-Year-Old Man with Multiple Sclerosis

Alvaro Guerra-AmorDermatology Department, Hospital Universitari Vall d’Hebrón, Barcelona, Spain;

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Ane Lopez-GonzalezPneumology Department, Hospital Universitari Vall d’Hebrón, Barcelona, Spain;

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Pau Bosch-NicolauTropical Medicine & International Health Unit Vall d’Hebrón—Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d’Hebron, Barcelona, Spain;

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Breogan Rodriguez-AcevedoNeurology-Neuroimmunology Service, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Barcelona, Spain;

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Ana ZabalzaNeurology-Neuroimmunology Service, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Barcelona, Spain;

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Elena SulleiroMicrobiology Department, University Hospital Vall d’Hebrón, Barcelona, Spain

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Juan Espinosa-PereiroTropical Medicine & International Health Unit Vall d’Hebrón—Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d’Hebron, Barcelona, Spain;

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Maria Luisa AznarTropical Medicine & International Health Unit Vall d’Hebrón—Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d’Hebron, Barcelona, Spain;

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Fernando SalvadorTropical Medicine & International Health Unit Vall d’Hebrón—Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d’Hebron, Barcelona, Spain;

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Adrián Sánchez-MontalváTropical Medicine & International Health Unit Vall d’Hebrón—Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d’Hebron, Barcelona, Spain;

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Israel MolinaTropical Medicine & International Health Unit Vall d’Hebrón—Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d’Hebron, Barcelona, Spain;

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ABSTRACT.

Leishmaniasis is a protozoan disease caused by species of genus Leishmania. Immunosuppression increases the risk of severe clinical forms and impairs response to treatment. The expansion of the use of immunomodulatory drugs for different conditions has raised the number of these cases. In this report, we present a case of visceral leishmaniasis in a patient with multiple sclerosis (MS) under fingolimod treatment. He presented with the triad of fever, visceromegaly, and pancytopenia and was diagnosed by the presence of amastigotes in a bone marrow sample. Furthermore, we discuss the previous published cases of MS patients under different immunosuppressant therapies to highlight its risk in endemic areas and suggest a therapeutic approach.

Author Notes

Address correspondence to Pau Bosch-Nicolau, Infectious Diseases Department. Hospital Universitari Vall d’Hebron, Universitat Autònoma de Barcelona, Passeig Vall d’Hebron 119-129, 08035 Barcelona, Spain. E-mail: pbosch@vhebron.net

These authors contributed equally to this work.

Authors’ addresses: Alvaro Guerra-Amor, Dermatology Department, Hospital Universitari Vall d’Hebrón, Barcelona, Spain, E-mail: aguerraamor@gmail.com. Ane Lopez-Gonzalez, Pneumology Department, Hospital Universitari Vall d’Hebrón, Barcelona, Spain, E-mail: anelopez95@gmail.com. Pau Bosch-Nicolau, Juan Espinosa-Pereiro, Maria Luisa Aznar, Fernando Salvador, Adrián Sánchez-Montalvá, and Israel Molina, Tropical Medicine & International Health Unit Vall d’Hebrón - Drassanes, Infectious Diseases Department, PROSICS Barcelona, University Hospital Vall d’Hebron, Barcelona, Spain, E-mails: pau.boschnicolau@gmail.com, juan.espinosa.pereiro@outlook.es, mlaznar@vhebron.net, fmsalvador@vhebron.net, adriansanchezmontalva@gmail.com, and israelmolina@ymail.com. Breogan Rodriguez-Acevedo and Ana Zabalza, Neurology-Neuroimmunology Service, Multiple Sclerosis Center of Catalonia (Cemcat), Hospital Universitari Vall d’Hebron, Barcelona, Spain, E-mails: brodriguez@cem-cat.org and azabalza@gmail.com. Elena Sulleiro, Microbiology Department, University Hospital Vall d’Hebrón, Barcelona, Spain, E-mail: esulleir@vhebron.net.

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