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Case Report: Cutaneous Leishmaniasis in a Rheumatoid Arthritis Patient Receiving Methotrexate

Valdir Sabbaga AmatoUniversidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Parasitologia, São Paulo, São Paulo, Brazil;
Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil;

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Regina Maia de SouzaUniversidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Parasitologia, São Paulo, São Paulo, Brazil;

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Lucas Augusto Moyses FrancoUniversidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Parasitologia, São Paulo, São Paulo, Brazil;
Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil;

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Roberta Cristina Ruedas MartinsUniversidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Parasitologia, São Paulo, São Paulo, Brazil;

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Camila Alves Maia da SilvaUniversidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Parasitologia, São Paulo, São Paulo, Brazil;

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Christini Takemi EmoriUniversidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil;

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Beatriz Julieta CelesteUniversidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Soroepidemiologia, São Paulo, São Paulo, Brazil;

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Gabriel Victor CastanheiraUniversidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Parasitologia, São Paulo, São Paulo, Brazil;
Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil;

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Felipe Francisco TuonLaboratory of Emerging Infectious Diseases, Pontificia Universidade Católica do Paraná, Curitiba, Paraná, Brazil

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ABSTRACT.

The immunosuppressive effect of methotrexate has rarely been associated with reactivation of cutaneous leishmaniasis. Here we present a case of a cutaneous leishmaniasis patient with atypical clinical symptoms without splenomegaly but with cutaneous manifestations after treatment of rheumatoid arthritis with methotrexate and blood recovery of the parasite. Next-generation sequencing was used to identify Leishmania infantum chagasi in the patient’s blood sample.

Author Notes

Address correspondence to Felipe Francisco Tuon, Rua Imaculada Conceição, 1155, Curitiba, Paraná, Brazil, 80215-901. E-mail: felipe.tuon@pucpr.br/flptuon@gmail.com

These authors contributed equally to this work.

Authors’ addresses: Valdir Sabbaga Amato, Instituto de Medicina Tropical Avenida Dr. Eneas Carvalho de Aguiar, 470 - jardim América São Paulo -SP, Brazil CEP 05403-000, E-mail: amato14@hotmail.com. Regina Maia de Souza, Instituto de Medicina Tropical Avenida Dr. Eneas Carvalho de Aguiar, 470 - jardim América São Paulo -SP, Brazil CEP 05403-000, E-mail: regina.maia@hc.fm.usp.br. Lucas Augusto Moyses Franco, Instituto de Medicina Tropical Avenida Dr. Eneas Carvalho de Aguiar, 470 - jardim América São Paulo -SP, Brazil CEP 05403-000, E-mail: lucasamfranco@hotmail.com. Roberta Cristina Ruedas Martins, Instituto de Medicina Tropical Avenida Dr. Eneas Carvalho de Aguiar, 470 - jardim América São Paulo -SP, Brazil CEP 05403-000, E-mail: betacristina@gmail.com. Camila Alves Maia da Silva, Instituto de Medicina Tropical Avenida Dr. Eneas Carvalho de Aguiar, 470 - jardim América São Paulo -SP, Brazil CEP 05403-000, E-mail: alvescamaia@gmail.com. Christini Takemi Emori, Instituto de Medicina Tropical Avenida Dr. Eneas Carvalho de Aguiar, 470 - jardim América São Paulo -SP, Brazil CEP 05403-000, E-mail: christinisp@yahoo.com.br. Beatriz Julieta Celeste, Instituto de Medicina Tropical Avenida Dr. Eneas Carvalho de Aguiar, 470 - jardim América São Paulo -SP, Brazil CEP 05403-000, E-mail: bjcelest@usp.br. Gabriel Victor Castanheira, Instituto de Medicina Tropical Avenida Dr. Eneas Carvalho de Aguiar, 470 - jardim América São Paulo -SP, Brazil CEP 05403-000, E-mail: gabriel.castanheira1996@gmail.com. Felipe Francisco Tuon, Rua Joao Pontoni 149, sl403. Curitiba, Brazil CEP 80050-490, E-mail: felipe.tuon@pucpr.br.

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