Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 15, Number 6—June 2009

Leishmaniasis, Autoimmune Rheumatic Disease, and Anti–Tumor Necrosis Factor Therapy, Europe

Ioannis D. Xynos, Maria G. Tektonidou, Dimitrios Pikazis, and Nikolaos V. SipsasComments to Author 
Author affiliations: National and Kapodistrian University of Athens, Athens, Greece (I.D. Xynos, D. Pikazis, N.V. Sipsas); Euroclinic Hospital of Athens, Athens (M.G. Tektonidou)

Main Article


Detailed characteristics of 15 patients with autoimmune rheumatic disorders in whom leishmaniasis developed, Europe*

Patient no. Country Age, y/sex Disease Anti-TNF treatment Other immunosuppressive treatments Form of
infection Ref.
Agent Duration, mo Agent(s) Duration, mo
1 France 66/M ANCA-associated vasculitis NA NA Cyclophosphamide, methotrexate, corticosteroids 120 Visceral (7)
2 Israel 56/M Rheumatoid arthritis NA NA Methotrexate, corticosteroids 120 Cutaneous (8)
3 Italy 35/M Behçet disease NA NA Chlorambucil, corticosteroids 36 Visceral (9)
4 Spain 50/M Rheumatoid arthritis NA NA Methotrexate, corticosteroids 120 Visceral (10)
5 Italy 60/M Polyarteritis nodosa NA NA Cyclophosphamide, corticosteroids 2 Visceral (11)
6 Spain 55/M Psoriatic arthritis Infliximab 9 No details given 300 Visceral (2)
7 Italy 76/M ANCA-associated vasculitis NA NA Cyclophosphamide, corticosteroids 36 Visceral (12)
8 France 53/F Rheumatoid arthritis Infliximab 12 Azathioprine, corticosteroids 12 Visceral (3)
9 Italy 69/F Rheumatoid arthritis Adalimumab 25 Methotrexate, corticosteroids 360 Visceral (4)
10 Greece 60/F Rheumatoid arthritis Etanercept 18† Cyclosporine, corticosteroids, anakinra 96 Visceral (5)
11 France 9/F Juvenile rheumatoid arthritis NA NA Cyclosporine, methotrexate, corticosteroids, anakinra 60 Visceral (13)
12 Greece 45/M Psoriatic arthritis Infliximab 60 Methotrexate, corticosteroids 60 Visceral (6)
13 Greece 65/F Rheumatoid arthritis NA NA Methotrexate 96 Visceral (14)
14 Greece 71/F Giant cell arteritis Infliximab 24 Methotrexate, corticosteroids 24 Visceral This study
15 Greece 55/M Ankylosing spondylitis Infliximab 12 Methotrexate 12 Cutaneous This study

*TNF, tumor necrosis factor; Ref., reference; ANCA, anti-neutrophil cytoplasmic antibody; NA, not applicable.
†All biologic treatments had been terminated 6 mo before leishmaniasis occurred.

Main Article

  1. Winthrop  KL. Risk and prevention of tuberculosis and other serious opportunistic infections associated with tumor necrosis factor. Nat Clin Pract Rheumatol. 2006;2:60210. DOIPubMedGoogle Scholar
  2. Romani-Costa  V, Sanchez  C, Moya  F, Estany  C. Visceral leishmaniasis related to infliximab administration. Enferm Infecc Microbiol Clin. 2004;22:310. DOIPubMedGoogle Scholar
  3. Fabre  S, Gibert  C, Lechiche  C, Dereure  J, Jorgesen  C, Sany  J. Visceral leishmaniasis infection in a rheumatoid arthritis patient treated with infliximab. Clin Exp Rheumatol. 2005;23:8912.PubMedGoogle Scholar
  4. Bassetti  M, Pizzorni  C, Gradoni  L, Del Bono  V, Cutolo  M, Viscoli  C. Visceral leishmaniasis infection in a rheumatoid arthritis patient treated with adalimumab. Rheumatology. 2006;45:14468. DOIPubMedGoogle Scholar
  5. Bagalas  V, Kioumis  I, Argyropoulou  P, Patakas  D. Visceral leishmaniasis infection in a patient with rheumatoid arthritis treated with etanercept. Clin Rheumatol. 2007;26:13445. DOIPubMedGoogle Scholar
  6. Tektonidou  MG, Skopouli  FN. Visceral leishmaniasis in a patient with psoriatic arthritis treated with infliximab: reactivation of a latent infection? Clin Rheumatol. 2008;27:5412. DOIPubMedGoogle Scholar
  7. Zanaldi  H, Rosenthal  E, Marty  P, Chichmanian  RM, Pesce  A, Cassuto  JP. Visceral leishmaniasis associated with Wegener disease. Use of lipid complex amphotericin B and liposomal amphotericin B. Presse Med. 1999;28:95961.PubMedGoogle Scholar
  8. Vardy  DA, Cohen  A, Kachko  L, Zvulunov  A, Frankenburg  S. Relapse of cutaneous leishmaniasis in a patient with an infected subcutaneous rheumatoid nodule. Br J Dermatol. 1999;141:9147. DOIPubMedGoogle Scholar
  9. Sirianni  MC, Barbone  B, Monarca  B, Nanni  M, Lagana  B, Aiuti  F. A case of Behçet’s disease complicated by visceral leishmaniasis and myelodysplasia: clinical considerations. Haematologica. 2001;86:10045.PubMedGoogle Scholar
  10. Baixauli Rubio  A, Rodriguez Gorriz  E, Campos Fernandez  J, Calvo Catala  J, Garcia Vicente  S. Enfermedad oportunista poco frecuente en enfermo tratamiento immunosupresor por arthritis reumatoide. . Anales de Medicina Interna (Madrid). 2003;20:2767.
  11. Scatena  P, Messina  F, Gori  S, Ruocco  L, Vignali  C, Menichetti  F, Visceral leishmaniasis in a patient treated for polyarteritis nodosa. Clin Exp Rheumatol. 2003;21(S32):S1213.PubMedGoogle Scholar
  12. Sollima  S, Corbellino  M, Piolini  R, Calattini  S, Imparato  S. Visceral leishmaniasis in a patient with Wegener’s granulomatosis. Rheumatology. 2004;43:9357. DOIPubMedGoogle Scholar
  13. Koné-Paut  I, Retornaz  K, Garnier  JM, Bader-Meunier  B. Visceral leishmaniasis in a patient with systemic juvenile arthritis treated by IL-1RA agonist (anakinra). Clin Exp Rheumatol. 2007;25:119.PubMedGoogle Scholar
  14. Venizelos  I, Tatsiou  Z, Papathomas  TG, Orazi  A. Visceral leishmaniasis in a rheumatoid arthritis patient treated with methotrexate. Int J Infect Dis. 2008; epub ahead of print.PubMedGoogle Scholar
  15. Cush  JJ. Biological drug use: US perspectives on indications and monitoring. Ann Rheum Dis. 2005;64:iv1823. DOIPubMedGoogle Scholar

Main Article

Page created: December 08, 2010
Page updated: December 08, 2010
Page reviewed: December 08, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.