Marcoval J, Penín R M, Sabé N, Valentí-Medina F, Bonfill-Ortí M, Martínez-Molina L
Department of Dermatology, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain.
Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, Spain.
Clin Exp Dermatol. 2017 Apr;42(3):331-334. doi: 10.1111/ced.13061. Epub 2017 Feb 27.
Leishmaniasis is endemic in several geographic areas of the world. In each of these areas, particular species of Leishmania with differing aggressiveness to humans predominate. In the European Mediterranean basin, cutaneous leishmaniasis usually presents with discrete, self-healing skin lesions. Although it is known that tumour necrosis factor (TNF) inhibitors may increase the risk of developing infections such as tuberculosis, there is scarce literature on Leishmania infections in patients treated with these drugs. In recent months, we have observed three patients resident in the Catalan coast of Spain who were treated with TNF inhibitors for Crohn disease, and who developed unusually large and persistent cutaneous lesions of leishmaniasis. These lesions responded only to treatment with intravenous liposomal amphotericin B. In countries with a high incidence of infection by aggressive species of Leishmania, serological screening may be indicated to detect a possible latent leishmanial infection before prescription of TNF inhibitors.
利什曼病在世界上的几个地理区域呈地方性流行。在这些区域中的每一个，对人类具有不同侵袭性的特定利什曼原虫物种占主导地位。在欧洲地中海盆地，皮肤利什曼病通常表现为离散的、可自愈的皮肤病变。尽管已知肿瘤坏死因子（TNF）抑制剂可能会增加发生诸如结核病等感染的风险，但关于接受这些药物治疗的患者发生利什曼原虫感染的文献却很少。最近几个月，我们观察到三名居住在西班牙加泰罗尼亚海岸的患者，他们因克罗恩病接受了TNF抑制剂治疗，并出现了异常大且持续的皮肤利什曼病病变。这些病变仅对静脉注射脂质体两性霉素B治疗有反应。在利什曼原虫侵袭性物种感染高发的国家，在开具TNF抑制剂之前，可能需要进行血清学筛查以检测可能的潜伏性利什曼原虫感染。
