Romero-Maté Alberto, Martínez-Sánchez Diego, Tardío Juan C, Moreno-Torres Amalia, García-Donoso Carmen, Aguado-Lobo Marta, Espinosa-Lara Pablo, Borbujo Jesús
Department of Dermatology, Hospital Universitario de Fuenlabrada, Madrid, Spain.
Dermatol Online J. 2012 Sep 15;18(9):7.
Human leishmaniasis produced by Leishmania infantum is endemic in Mediterranean countries. In the context of a leishmaniasis outbreak in the town of Fuenlabrada, Madrid, Spain, we had two patients with cutaneous leishmaniasis that developed non-necrotizing cutaneous granulomas. They had both been receiving anti-TNF treatment with adalimumab for rheumatic diseases. Neither of them developed visceral disease and did not require anti-TNF treatment withdrawal to control the cutaneous disease. It is well known that anti-TNF therapy is associated with opportunistic diseases, especially with those in which granuloma formation is an important part of the host defence, as in tuberculosis. We think that granuloma formation through activation of Toll-like receptor-9 and via induction of a Th17 response may be precipitated by the parasites in the dermis.
由婴儿利什曼原虫引起的人类利什曼病在地中海国家呈地方性流行。在西班牙马德里富恩拉夫拉达镇发生利什曼病疫情的背景下，我们有两名皮肤利什曼病患者出现了非坏死性皮肤肉芽肿。他们都因风湿性疾病接受了阿达木单抗抗TNF治疗。两人均未发展为内脏疾病，也无需停用抗TNF治疗来控制皮肤疾病。众所周知，抗TNF治疗与机会性疾病有关，尤其是与那些肉芽肿形成是宿主防御重要组成部分的疾病有关，如结核病。我们认为，真皮中的寄生虫可能会通过激活Toll样受体-9并诱导Th17反应来促使肉芽肿形成。
