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Case Reports
. 2014 Jul;91(1):81-3.
doi: 10.4269/ajtmh.13-0578. Epub 2014 Apr 14.

Reactivation of mucosal and cutaneous leishmaniasis in a renal transplanted patient

Felipe F Tuon  1 , Giovana Marina Bombonatto  2 , Eveline Roesler Battaglin  2 , Marcus Henrique Sakumoto  2 , Valdir Sabbaga Amato  2 , Raphael Abegão de Camargo  2 , Antônio Carlos Nicodemo  2
Affiliations
Case Reports

Reactivation of mucosal and cutaneous leishmaniasis in a renal transplanted patient

Felipe F Tuon et al. Am J Trop Med Hyg. 2014 Jul.

Abstract

Mucosal leishmaniasis (ML) is a chronic form of tegumentary leishmaniasis, which causes destructive lesions of nasal, pharyngeal, and laryngeal mucosa. We describe a case of leishmaniasis reactivation with simultaneous cutaneous and mucosal forms in a renal transplanted patient with no history of prior leishmaniasis. Reactivation after renal transplantation was not reported in Brazil. A 67-year-old woman receiving prednisone 20 mg/day, tacrolimus 1 mg/day, and mycophenolic acid 360 mg/day presented with nose edema with erythema and cutaneous lesions. Amastigotes were identified on biopsies and the polymerase chain reaction confirmed Leishmania (Viannia) braziliensis. The patient was treated with liposomal amphotericin B but died 3 weeks after as a result of bacterial septic shock. In conclusion, tegumentary leishmaniasis can reactivate with simultaneous cutaneous and mucosal forms in a renal transplanted patient during the immunosuppressant therapy.

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Figures

Figure 1.
Figure 1.
(A) Cutaneous reactivation of American tegumentary leishmaniasis in a renal transplanted patient. (B) The cutaneous lesion of the leg is amplified. (C) External aspect of mucosal reactivation of American tegumentary leishmaniasis in a renal transplanted patient. (D) Computed tomography scan showing mucosal swelling with destruction of nasal septum.
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