Clinical aspects and management of cutaneous leishmaniasis in rheumatoid patients treated with TNF-α antagonists

Travel Med Infect Dis. 2013 Nov-Dec;11(6):412-20. doi: 10.1016/j.tmaid.2013.05.003. Epub 2013 Aug 22.


Patients under immunosuppressive therapy with tumor necrosis factor alpha (TNF-α) antagonists are vulnerable to various opportunistic infections including leishmaniasis. We present a case series of 8 travellers developing cutaneous leishmaniasis whilst on TNF-α antagonist treatment and review the literature on aspects of cutaneous leishmaniasis developing in patients treated with TNF-α antagonists. We make interim recommendations regarding the drug therapy used to maintain remission in travellers with rheumatoid disease travelling to leishmania prone areas. Despite having a medical condition requiring continued rheumatological review the interval to diagnosis appears not to be reduced compared to that described in non-rheumatoid patients. Rheumatologists and family doctors should be aware of the need for post-travel surveillance for leishmaniasis in rheumatoid patients on TNF-alpha antagonist treatment.

Keywords: Cutaneous leishmaniasis; Immunosuppression; Rheumatology; TNF-alpha antagonists; Treatment.

MeSH terms

  • Adult
  • Anti-Inflammatory Agents / therapeutic use*
  • Antiprotozoal Agents / therapeutic use*
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / parasitology*
  • Female
  • Humans
  • Leishmaniasis, Cutaneous / complications
  • Leishmaniasis, Cutaneous / drug therapy*
  • Male
  • Middle Aged
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors*


  • Anti-Inflammatory Agents
  • Antiprotozoal Agents
  • Tumor Necrosis Factor-alpha