First Case Report of Cutaneous Leishmaniasis Caused by Leishmania (Leishmania) infantum in a Brazilian Patient Treated with Adalimumab

Leishmania (Leishmania) infantum is the main etiologic agent of visceral leishmaniasis in American continent. We report a rare case of cutaneous leishmaniasis caused by viscerotropic specie in a patient with ankylosing spondylitis on treatment with adalimumabe and methotrexate. The patient presented no signs of visceral involvement. PCRRFLP and genetic sequencing demonstrated Leishmania (Leishmania) infantum. The patient was treated with Nmethyl-glucamine (20 mgSbV/kg/day) for 20 days. Despite of interruption of treatment due to elevation of transaminases (TGO 48 U/L and TGP 62 U/L) for a week, the lesions healed completely. Leishmania infection in patients who are on anti-TNF alpha treatment has to be remembered as an opportunistic disease associated with immunosuppression caused by biological therapies, especially in endemic countries. We consider that the use of immunosuppressive drugs may lead to atypical cases of cutaneous leishmaniasis even by viscerotropic agents.