Marcoval Joaquim, Penín Rosa M
Department of Dermatology, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain.
Department of Pathology, Hospital Universitari de Bellvitge, IDIBELL, University of Barcelona, Barcelona, Spain.
Int J Dermatol. 2017 Jul;56(7):750-753. doi: 10.1111/ijd.13588. Epub 2017 Mar 1.
Although with a lower incidence than in other geographic areas, leishmaniasis is also endemic on the European Mediterranean coast. However, there are few studies on the clinical features of cutaneous lesions of leishmaniasis in Europe. Our objective was to review the clinical features of cutaneous leishmanial lesions in our European Mediterranean population in the last 30 years and compare the clinical features of immunosuppressed and nonimmunosuppressed patients.
The clinical features of cutaneous lesions of leishmaniasis diagnosed between 1987 and 2016 at Bellvitge Hospital in Barcelona, Spain, were retrospectively analyzed.
Cutaneous lesions of leishmaniasis were diagnosed in 68 patients (40 male and 28 female, mean age 53.60 years, SD 19.68). Thirteen patients were immunosuppressed because of acquired immune deficiency syndrome (AIDS) (7), renal transplantation (1), lymphoma (1), and anti-TNF agents (4). Our immunosuppressed patients had more lesions (3.33 vs. 1.80, P = 0.021), with greater maximum diameter (33.00 vs. 13.33 mm, P = 0.001), and their lesions were more frequently disseminated (P = 0.008). Visceral leishmaniasis was observed only in immunosuppressed patients. Patients treated with anti-TNF drugs developed unusually large skin lesions with crusted, eroded surfaces and without a tendency to spontaneous remission.
With the widespread use of anti-TNF agents, an increase in severe forms of leishmaniasis can be expected. The development of persistent, crusted, or eroded erythematous-brownish plaques in patients treated with anti-TNF drugs who live or had traveled to endemic areas of Leishmania infection warrants consideration of a diagnosis of cutaneous leishmaniasis.
尽管利什曼病在欧洲地中海沿岸的发病率低于其他地理区域，但它在该地区也是地方病。然而，欧洲关于利什曼病皮肤病变临床特征的研究较少。我们的目的是回顾过去30年中我们欧洲地中海人群中皮肤利什曼病病变的临床特征，并比较免疫抑制和非免疫抑制患者的临床特征。
回顾性分析了1987年至2016年在西班牙巴塞罗那贝尔维特奇医院诊断的利什曼病皮肤病变的临床特征。
68例患者被诊断为利什曼病皮肤病变（男性40例，女性28例，平均年龄53.60岁，标准差19.68）。13例患者因获得性免疫缺陷综合征（艾滋病）（7例）、肾移植（1例）、淋巴瘤（1例）和抗TNF药物（4例）而免疫抑制。我们的免疫抑制患者有更多的病变（3.33比1.80，P = 0.021），最大直径更大（33.00比13.33毫米，P = 0.001），并且他们的病变更频繁地播散（P = 0.008）。仅在免疫抑制患者中观察到内脏利什曼病。接受抗TNF药物治疗的患者出现异常大的皮肤病变，表面结痂、糜烂，且无自发缓解倾向。
随着抗TNF药物的广泛使用，预计严重形式的利什曼病会增加。在生活或曾前往利什曼原虫感染流行地区且接受抗TNF药物治疗的患者中，出现持续的、结痂的或糜烂的红棕色斑块，应考虑诊断为皮肤利什曼病。
