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[Leishmaniasis in rheumatoid arthritis]
C Pizzorni1, M E Secchi, M Cutolo
1U.O. Clinica Reumatologica, Dipartimento di Medicina Interna Università di Genova, Genova, Italia. carmenpizzorni@virgilio.it
Reumatismo
|September 28, 2007
Summary
Anti-tumor necrosis factor-alpha (TNF-alpha) therapy can increase infection risk. This case study reports visceral leishmaniasis in a patient receiving adalimumab, highlighting the need for monitoring in high-risk individuals.
Area of Science:
- Immunology
- Infectious Diseases
- Parasitology
Background:
- Leishmaniasis presents diverse clinical and epidemiological forms, with visceral leishmaniasis being fatal if untreated.
- Cellular immune responses, particularly Th1 type, are crucial for protection against Leishmania infection.
- Tumor necrosis factor-alpha (TNF-alpha) plays a role in controlling intracellular Leishmania donovani infections.
Observation:
- Anti-TNF-alpha therapies, like adalimumab, are effective for conditions such as rheumatoid arthritis.
- However, the use of TNF-alpha antagonists has been linked to an increased incidence of infections.
- This report details the first documented case of visceral leishmaniasis in a patient undergoing long-term treatment with adalimumab.
Findings:
- The study presents a unique case of visceral leishmaniasis developing in a patient treated with adalimumab.
- This finding underscores a potential adverse effect of anti-TNF-alpha therapy.
Implications:
- Systematic screening for leishmaniasis in all biologic-treated patients may not be necessary due to low incidence.
- Periodical serological monitoring for leishmaniasis is recommended for patients on anti-TNF monoclonal antibody therapy who are at high risk of exposure.
- This highlights the importance of risk-benefit assessment in immunosuppressive therapies.
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