Abstract
The use of tumor necrosis factor α as a treatment for chronic inflammatory conditions has been shown to be associated with an increased risk of developing infections, especially Mycobacterium tuberculosis, atypical mycobacteria, and other microorganisms. We report the case of a 58-year-old man with ankylosing spondylitis, receiving infliximab treatment, who presented with multiple plaques on the face, chest, and extremities, a thickened, tender ulnar nerve, and severe neuritis of the feet. The results of a biopsy of these lesions revealed histopathological features of lepromatous Hansen disease. The use of anti-tumor necrosis factor biologic agent on this patient may have resulted in either a new infection or reactivation of a latent infection of Mycobacterium leprae.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Manadan AM, James N, Block JA (2007) New therapeutic approaches for spondyloarthritis. Curr Opin Rheumatol 19:259–264
Tektonidou MG, Skopouli FN (2008) Visceral leishmaniasis in a patient with psoriatic arthritis treated with infliximab: reactivation of a latent infection? Clin Rheumatol 27:541–542
Cepeda EJ, Williams FM, Ishimori ML, Weisman MH, Reveille JD (2008) The use of anti-tumor necrosis factor therapy in HIV-positive individuals with rheumatic disease. Ann Rheum Dis 67:710–712
Scollard DM, Joyce MP, Gillis TP (2006) Development of leprosy and type 1 leprosy reactions after treatment with infliximab: a report of 2 cases. Clin Infect Dis 43:19–22
Faber WR, Jensema AJ, Goldschmidt WF (2006) Treatment of recurrent erythemanodosum leprosum with infliximab. N Engl J Med 355(7):739
da Silva Sobrinho RA, Mathias TA (2008) Prospects for the elimination of leprosy as a public health problem in the state of Paraná, Brazil. Cad Saude Publica 24(2):303–314
Kerr-Pontes LRS, Barreto ML, Evangelista CMN, Rodrigues LC, Heukelbach, Feldmeier H (2006) Socioeconomic, environmental, and behavioral risk factors for leprosy in North-east Brazil: results of a case-control study. Int J Epidemiol 5(4):994–1000
Ellerin T, Rubin RH, Weinblatt ME (2003) Infections and anti-tumour necrosis factor alpha therapy. Arthristis Rheum 48:3013–3022
Handerson C, Davis JC (2006) Drug insight: anti-tumor-necrosis-factor therapy for ankylosing spondylitis. Nat Clin Pract Rheumatol 2(4):211–218
Clegg DO (2006) Treatment of ankylosing spodylitis. J Rheumatol 35(suppl 78):24–31
Furst DE, Breedveld FC, Kalden JR et al (2007) Updated consensus statement on biological agents for the treatment of rheumatic disease, 2007. Ann Rheum Dis 66:2–22
Askling J, Dixon W (2008) The safety of anti-tumour necrosis factor therapy in rheumatoid arthritis. Curr Opin Rheumatol 20:138–144
Oberstein EM, Kromo O, Tozman EC (2008) Type I reaction of Hansen's disease with exposure to adalimumab: a case report. Arthritis Rheum 59(7):1040–1043
Lockwood DN, Suneetha S (2005) Leprosy: too complex a disease for a simple elimination paradigm. Bull World Health Organ 83(3):230–235
Disclosures
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Vilela Lopes, R., Barros Ohashi, C., Helena Cavaleiro, L. et al. Development of leprosy in a patient with ankylosing spondylitis during the infliximab treatment: reactivation of a latent infection?. Clin Rheumatol 28, 615–617 (2009). https://doi.org/10.1007/s10067-009-1140-0
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-009-1140-0