Cutaneous leishmaniasis in a patient receiving infliximab for psoriatic arthritis: treatment with cryotherapy and intralesional meglumine antimonate.

We report the case of a 33-year-old man referred to our department with a skin ulcer that had appeared 1 year earlier on the left posterior axillary fold. His medical history was remarkable for chronic hepatitis B infection being treated with adefovir and for psoriatic arthritis, under treatment with leflunomide 20 mg/d, prednisone 5 mg/d, and infliximab 5 mg/kg every 8 weeks for the past 2 years. Physical examination revealed an ulcerated plaque measuring 9 × 6 cm and several erythematous-scaling papules measuring 1 to 2 cm on and around the plaque (Fig. 1A). There was no evidence of enlarged lymph nodes, liver, or spleen on palpation. Histologic examination showed a mixed inflammatory infiltrate with lymphocytes, histiocytes, and some macrophages with intracellular and extracellular Leishmania amastigotes (Fig. 2). Two additional biopsies were performed to complete the study. Giemsa staining of one of the biopsy specimens showed scarce amastigotes and culture of the other specimen was positive for Leishmania species. The subtype could not be identified. Mycobacterial culture was negative and the fungal culture was positive for Candida albicans. Serology showed a Leishmania antibody titer of 1:80. No parasite material was detected by Giemsa stains or culture of bone marrow aspirate smears. The organs did not appear enlarged on abdominal ultrasound and the blood workup showed mild neutropenia (1.64 × 10/L) and thrombocytopenia (127 × 10/L); the results of the liver and kidney function tests were normal.