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She reported a recent history of weight loss, dry cough and dyspnoea, and was investigated for pancytopenia and hepatosplenomegaly.<\/jats:p>\n                  <jats:p>Bone marrow biopsy confirmed the diagnosis of visceral leishmaniasis and she responded well to treatment with intravenous liposomal amphotericin B. Recent rheumatological treatment with adalimumab, a monoclonal antibody to tumour necrosis factor \u03b1, was thought to be the factor responsible for causing the cutaneous lesion to become disseminated. This case highlights an unexpected adverse effect of novel immunosuppressants. As the use of biologics becomes widespread, there is an increasing need for clinical surveillance.<\/jats:p>","DOI":"10.1136\/bcr.04.2010.2878","type":"journal-article","created":{"date-parts":[[2010,10,13]],"date-time":"2010-10-13T13:18:42Z","timestamp":1286975922000},"page":"bcr0420102878","source":"Crossref","is-referenced-by-count":11,"title":["Let off the leash: kala-azar following the use of tumour necrosis factor antibodies"],"prefix":"10.1136","volume":"2010","author":[{"given":"Anjum","family":"Khan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerald","family":"Coakley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Cosgrove","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Lockwood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2010,10,13]]},"reference":[{"key":"2025082805211413000_2010.oct12_2.bcr0420102878.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa011110"},{"key":"2025082805211413000_2010.oct12_2.bcr0420102878.2","unstructured":"World Health Organization, 2010. http:\/\/www.who.int\/leishmaniasis\/burden\/magnitude\/burden_magnitude\/en\/index.html (Accessed 16 August 2010)."},{"key":"2025082805211413000_2010.oct12_2.bcr0420102878.3","first-page":"199","article-title":"Change in human visceral leishmaniasis treatment in Italy","volume":"46","author":"Gradoni","year":"2004","journal-title":"Parassitilogia"},{"key":"2025082805211413000_2010.oct12_2.bcr0420102878.4","first-page":"235","article-title":"[Leishmaniasis in rheumatoid arthritis]","volume":"59","author":"Pizzorni","year":"2007","journal-title":"Reumatismo"},{"key":"2025082805211413000_2010.oct12_2.bcr0420102878.5","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kel235"},{"key":"2025082805211413000_2010.oct12_2.bcr0420102878.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.eimc.2009.03.017"},{"key":"2025082805211413000_2010.oct12_2.bcr0420102878.7","doi-asserted-by":"publisher","DOI":"10.1592\/phco.2005.25.9.1181"},{"key":"2025082805211413000_2010.oct12_2.bcr0420102878.8","doi-asserted-by":"publisher","DOI":"10.1002\/eji.200737662"},{"key":"2025082805211413000_2010.oct12_2.bcr0420102878.9","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2249.2006.03171.x"},{"key":"2025082805211413000_2010.oct12_2.bcr0420102878.10","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.68.11.6289-6293.2000"},{"key":"2025082805211413000_2010.oct12_2.bcr0420102878.11","doi-asserted-by":"crossref","first-page":"3504","DOI":"10.4049\/jimmunol.162.6.3504","article-title":"Structural deficiencies in granuloma formation in TNF gene-targeted mice underlie the heightened susceptibility to aerosol Mycobacterium tuberculosis infection, which is not compensated for by lymphotoxin","volume":"162","author":"Bean","year":"1999","journal-title":"J Immunol"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr.04.2010.2878","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T12:21:23Z","timestamp":1756383683000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr.04.2010.2878"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2010]]},"references-count":11,"alternative-id":["10.1136\/bcr.04.2010.2878"],"URL":"https:\/\/doi.org\/10.1136\/bcr.04.2010.2878","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2010]]}}}