{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T18:34:01Z","timestamp":1789842841553,"version":"4.0.1"},"reference-count":15,"publisher":"BMJ","issue":"2","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,1,28]]},"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:p>Tumor necrosis factor (TNF) inhibitors are associated with a higher risk of infection. Cases of cutaneous leishmaniasis have been rarely reported in this population, mostly with those taking adalimumab and infliximab.<\/jats:p>\n               <jats:p>A man in his 60s with chronic plaque psoriasis developed a cutaneous lesion on his leg after 2 years of adalimumab therapy. It was initially misdiagnosed and unsuccessfully treated as a bacterial ulcer, but a skin biopsy later confirmed <jats:italic>Leishmania donovani<\/jats:italic> complex infection. Adalimumab was discontinued, and the patient was treated with intravenous liposomal amphotericin B, leading to the resolution of the ulcers. His psoriasis worsened post-treatment but was managed with risankizumab, and 2 years later, no evidence of leishmaniasis relapse was noted.<\/jats:p>\n               <jats:p>This case highlights the importance of vigilance for leishmaniasis in patients taking TNF inhibitors, especially in endemic regions, as diagnosis can be challenging. Although there is no consensus on managing leishmaniasis in this population, treatment often involves discontinuing TNF inhibitors and using systemic antileishmanial drugs.<\/jats:p>","DOI":"10.1136\/bcr-2024-263139","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T12:46:40Z","timestamp":1739278000000},"page":"e263139","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Atypical cutaneous leishmaniasis in a patient under tumour necrosis factor alpha inhibitor for psoriasis"],"prefix":"10.1136","volume":"18","author":[{"given":"Cesar","family":"Magalhaes","sequence":"first","affiliation":[{"name":"Dermatology, Unidade Local de Saude de Vila Nova de Gaia\/Espinho, Vila Nova de Gaia, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diogo","family":"Teixeira","sequence":"additional","affiliation":[{"name":"Dermatology, Unidade Local de Saude de Vila Nova de Gaia\/Espinho, Vila Nova de Gaia, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"Coelho","sequence":"additional","affiliation":[{"name":"Pathology, Laborat\u00f3rio de Anatomia Patol\u00f3gica (LAP) Unilabs Portugal, Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6938-4514","authenticated-orcid":false,"given":"Luis","family":"Malheiro","sequence":"additional","affiliation":[{"name":"Infectious Diseases, Unidade Local de Saude de Vila Nova de Gaia\/Espinho, Vila Nova de Gaia, Portugal"},{"name":"Infectious Diseases, Faculdade de Medicina da Universidade do Porto, Porto, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,2,11]]},"reference":[{"key":"2025082803504190000_18.2.e263139.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2014.08.051"},{"key":"2025082803504190000_18.2.e263139.2","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1111\/ced.13061","article-title":"Cutaneous leishmaniasis associated with anti-tumour necrosis factor-\u03b1 drugs: an emerging disease","volume":"42","author":"Marcoval","year":"2017","journal-title":"Clin Exp Dermatol"},{"key":"2025082803504190000_18.2.e263139.3","doi-asserted-by":"crossref","first-page":"S189","DOI":"10.1086\/429994","article-title":"Tumor necrosis factor and chemokine interactions in the formation and maintenance of granulomas in tuberculosis","volume":"41 Suppl 3","author":"Algood","year":"2005","journal-title":"Clin Infect Dis"},{"key":"2025082803504190000_18.2.e263139.4","doi-asserted-by":"crossref","first-page":"2839","DOI":"10.1128\/iai.59.8.2839-2842.1991","article-title":"Role of tumor necrosis factor in macrophage leishmanicidal activity in vitro and resistance to cutaneous leishmaniasis in vivo","volume":"59","author":"Theodos","year":"1991","journal-title":"Infect Immun"},{"key":"2025082803504190000_18.2.e263139.5","doi-asserted-by":"crossref","first-page":"1376262","DOI":"10.3389\/fphar.2024.1376262","article-title":"Comparisons of infection events associated with tumor necrosis factor inhibitors in patients with inflammatory arthritis: A systematic review and network meta-analysis","volume":"15","author":"Jiang","year":"2024","journal-title":"Front Pharmacol"},{"key":"2025082803504190000_18.2.e263139.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.medcli.2010.11.032"},{"key":"2025082803504190000_18.2.e263139.7","first-page":"253","article-title":"Position paper on tuberculosis screening in patients with immune mediated inflammatory diseases candidates for biological therapy","volume":"37","author":"Duarte","year":"2012","journal-title":"Acta Reumatol Port"},{"key":"2025082803504190000_18.2.e263139.8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1574-695X.2007.00311.x"},{"key":"2025082803504190000_18.2.e263139.9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.abd.2020.06.002","article-title":"Consensus on the diagnosis and management of chronic leg ulcers - 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