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The examination revealed a papulonodular lesion in the right pretibial region measuring 2<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm. It was hard with an erosive-crusted centre (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, A and B) and several similar smaller lesions were seen on the same leg, the left mandibular ramus and the left ear lobe (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C and D). The histological study revealed a diffuse dermatitis with a lymphoplasmacytic and histiocytic component, not granulomatous (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>A), with intracytoplasmic structures (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>B). A nested PCR and IgG serology were performed, and both were positive for leishmaniasis. After ruling out visceral involvement, treatment was started with i/m meglumine antimoniate 1,500<span class="elsevierStyleHsp" style=""></span>mg/day for 20 days, with complete resolution of the lesions.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Leishmaniasis is an endemic disease in our area, caused by obligate intracellular protozoa residing in the macrophages, and it requires the TNF action to control its infection, as do other intracellular infections. In patients immunosuppressed by anti-TNF, leishmaniasis can be caused by reactivation of a latent infection or by a primary infection. It is therefore advisable to suspect this disease in the presence of compatible skin lesions in patients with this treatment in endemic areas, in order to establish suitable treatment.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sánchez-Bernal J, Aldea-Manrique B, Abadías-Granado I, Ara-Martín M. Leishmaniasis cutánea múltiple en paciente con colitis ulcerosa en tratamiento con adalimumab. Med Clin (Barc). 2021;156:475.</p>" ] ] "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1597 "Ancho" => 1667 "Tamanyo" => 398837 ] ] ] 1 => array:6 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1113 "Ancho" => 1667 "Tamanyo" => 448596 ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015600000009/v1_202105020816/S2387020621001546/v1_202105020816/en/main.assets" "Apartado" => array:4 [ "identificador" => "51820" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015600000009/v1_202105020816/S2387020621001546/v1_202105020816/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621001546?idApp=UINPBA00004N" ]
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Image in medicine
Multiple cutaneous leishmaniasis in patient with ulcerative colitis under treatment with adalimumab
Leishmaniasis cutánea múltiple en paciente con colitis ulcerosa en tratamiento con adalimumab
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Javier Sánchez-Bernal
, Beatriz Aldea-Manrique, Isabel Abadías-Granado, Mariano Ara-Martín
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Servicio de Dermatología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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