Anti-tumour necrosis factor-induced visceral and cutaneous leishmaniasis: Case report and review of the literature

Alba Català*, Esther Roé, Joan Dalmau, Virginia Pomar, Carme Muñoz, Oriol Yelamos, Luis Puig

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

32 Citations (Scopus)


Background: Leishmaniasis is a chronic protozoan disease in which organisms are found within phagolysosomes of the mononuclear phagocyte system. There are three major forms: cutaneous, mucocutaneous and visceral. We report the first case of visceral leishmaniasis with cutaneous involvement in a patient with rheumatoid arthritis treated with the anti-tumour necrosis factor (anti-TNF) adalimumab. Objective: To highlight cutaneous leishmaniasis as the first indicator of a kala-azar disease in a patient treated with anti-TNF and to review the literature on leishmaniasis in the context of anti-TNF therapy. Case Report: A 59-year-old woman presented with a crusted plaque on the right elbow 34 months after the initiation of adalimumab. A cutaneous biopsy showed intracellular amastigotes. No Leishmania parasites were observed in a bone marrow aspirate, but laboratory tests showed anaemia and impaired liver function, abdominal ultrasonography showed hepatomegaly, and ELISA serology was strongly positive for Leishmania antibodies in serum and urine. Adalimumab was withdrawn and treatment combining intralesional pentavalent antimonials and liposomal amphotericin was started. Eight weeks later, the leishmaniasis had resolved. Conclusion: A skin biopsy disclosing leishmaniasis should prompt tests to rule out visceral leishmaniasis, especially in an area such as the Mediterranean where the prevalence of latent Leishmania infection is high.

Original languageAmerican English
Pages (from-to)204-207
Number of pages4
Issue number3
Publication statusPublished - 19 Mar 2015


  • Adalimumab
  • Anti-tumour necrosis factor
  • Cutaneous leishmaniasis
  • Leishmaniasis
  • Liposomal amphotericin
  • Pentavalent antimonials
  • Rheumatoid arthritis
  • Tumour necrosis factor-α


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