{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T03:38:00Z","timestamp":1774669080715,"version":"3.50.1"},"reference-count":28,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T00:00:00Z","timestamp":1759881600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>Introduction: Cutaneous leishmaniasis (CL) poses a number of challenges when it comes to diagnosis and treatment, due to the variety of clinical presentations that mimic other conditions and hinder the choice of the most appropriate therapeutic approach, especially in the context of immunodepression. Case presentation: We present the case of a 63-year-old woman on anti-tumor necrosis factor (TNF) therapy, who underwent surgical excision for the diagnostic purposes of a chronic non-healing lesion located on her right arm. The histopathological examination revealed the presence of Leishmania amastigotes. CL relapsed in the following months, with new lesions appearing both close to the excision scar and at a different body site. At this point, in order to avoid another surgical intervention, cutaneous swabs for Leishmania Polymerase Chain Reaction (PCR) were performed on both lesions. Both samples yielded positive results, and the patient was treated with a 4-week course of miltefosine. Conclusions: These results support the use of cutaneous swabs as a highly sensitive and less invasive tool for the diagnostic workup of CL. In addition, our case prompts a reflection on the management of immunosuppressed patients with CL, with particular emphasis on the risk of reactivation or simultaneous involvement of multiple anatomical sites, thus suggesting the need for specific considerations and personalized management for this group of subjects.<\/jats:p>","DOI":"10.3390\/idr17050125","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T12:04:52Z","timestamp":1759925092000},"page":"125","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Cutaneous Leishmaniasis in the Immunocompromised: Diagnostic and Therapeutic Insights from a Case Documented in Central Italy"],"prefix":"10.3390","volume":"17","author":[{"given":"Laura","family":"Povolo","sequence":"first","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4152-9346","authenticated-orcid":false,"given":"Anna","family":"Barbiero","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy"},{"name":"Regional Referral Center for Tropical Diseases, Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5377-7118","authenticated-orcid":false,"given":"Michele","family":"Spinicci","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy"},{"name":"Regional Referral Center for Tropical Diseases, Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy"},{"name":"Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2585-7567","authenticated-orcid":false,"given":"Nicola","family":"Petrosillo","sequence":"additional","affiliation":[{"name":"Infection Prevention & Control\/Infectious Disease Service, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9758-1523","authenticated-orcid":false,"given":"Alessandro","family":"Bartoloni","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy"},{"name":"Regional Referral Center for Tropical Diseases, Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy"},{"name":"Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0892-8404","authenticated-orcid":false,"given":"Lorenzo","family":"Zammarchi","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy"},{"name":"Regional Referral Center for Tropical Diseases, Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy"},{"name":"Infectious and Tropical Diseases Unit, Careggi University Hospital, 50134 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Guery, R., Walker, S.L., Harms, G., Neumayr, A., Van Thiel, P., Gangneux, J.P., Clerinx, J., S\u00f6birk, S.K., Visser, L., and Lachaud, L. (2021). Clinical diversity and treatment results in Tegumentary Leishmaniasis: A European clinical report in 459 patients. PLoS Negl. Trop. Dis., 15.","DOI":"10.1371\/journal.pntd.0009863"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Maia, C., Concei\u00e7\u00e3o, C., Pereira, A., Rocha, R., Ortu\u00f1o, M., Mu\u00f1oz, C., Jumakanova, Z., P\u00e9rez-Cutillas, P., \u00d6zbel, Y., and T\u00f6z, S. (2023). The estimated distribution of autochthonous leishmaniasis by Leishmania infantum in Europe in 2005\u20132020. PLoS Negl. Trop. Dis., 17.","DOI":"10.1371\/journal.pntd.0011497"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Kassi, M., Kassi, M., Afghan, A.K., Rehman, R., and Kasi, P.M. (2008). Marring leishmaniasis: The stigmatization and the impact of cutaneous leishmaniasis in Pakistan and Afghanistan. PLoS Negl. Trop. Dis., 2.","DOI":"10.1371\/journal.pntd.0000259"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1111\/1469-0691.12556","article-title":"Leishmaniasis in immunosuppressed individuals","volume":"20","author":"Carrillo","year":"2014","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Gramiccia, M., Scalone, A., Di Muccio, T., Orsini, S., Fiorentino, E., and Gradoni, L. (2013). The burden of visceral leishmaniasis in Italy from 1982 to 2012: A retrospective analysis of the multi-annual epidemic that occurred from 1989 to 2009. Eurosurveillance, 18.","DOI":"10.2807\/1560-7917.ES2013.18.28.20535"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/0035-9203(80)90126-1","article-title":"Leishmaniasis in Tuscany (Italy). (III) The prevalence of canine leishmaniasis in two foci of Grosseto Province","volume":"74","author":"Gradoni","year":"1980","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Franceschini, E., Puzzolante, C., Menozzi, M., Rossi, L., Bedini, A., Orlando, G., Gennari, W., Meacci, M., Rugna, G., and Carra, E. (2016). Clinical and Microbiological Characteristics of Visceral Leishmaniasis Outbreak in a Northern Italian Nonendemic Area: A Retrospective Observational Study. BioMed Res. Int., 2016.","DOI":"10.1155\/2016\/6481028"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Varani, S., Cagarelli, R., Melchionda, F., Attard, L., Salvadori, C., Finarelli, A.C., Gentilomi, G.A., Tigani, R., Rangoni, R., and Todeschini, R. (2013). Ongoing outbreak of visceral leishmaniasis in Bologna Province, Italy, November 2012 to May 2013. Eurosurveillance, 18.","DOI":"10.2807\/1560-7917.ES2013.18.28.20530"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Barbiero, A., Spinicci, M., Aiello, A., Maruotto, M., Antonello, R.M., Formica, G., Piccica, M., Isola, P., Parisio, E.M., and Nardone, M. (2024). The Uprise of Human Leishmaniasis in Tuscany, Central Italy: Clinical and Epidemiological Data from a Multicenter Study. Microorganisms, 12.","DOI":"10.3390\/microorganisms12101963"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez, C., Calder\u00f3n, J.M., L\u00f3pez, A.M., Bernardini, I., Gradoni, L., Pombi, M., Bongiorno, G., and Gabrielli, S. (2025). Species-specific variation in predicted distribution and habitat suitability of phlebotomine sand flies in Italy under different climate change scenarios. Sci. Rep., 15.","DOI":"10.1038\/s41598-025-96296-w"},{"key":"ref_11","unstructured":"(2025, May 12). Manual on Case Management and Surveillance of the Leishmaniases in the WHO European Region. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789289052511."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.idc.2018.10.004","article-title":"Cutaneous Leishmaniasis: Updates in Diagnosis and Management","volume":"33","author":"Aronson","year":"2019","journal-title":"Infect. Dis. Clin. N. Am."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Boni, S.M., Oyafuso, L.K., Soler, R.D.C., and Lindoso, J.A.L. (2019). Efficiency of noninvasive sampling methods (swab) together with Polymerase Chain Reaction (PCR) for diagnosing American Tegumentary Leishmaniasis. Rev. Inst. De Med. Trop. S\u00e3o Paulo, 59.","DOI":"10.1590\/s1678-9946201759038"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Silgado, A., Armas, M., S\u00e1nchez-Montalv\u00e1, A., Goterris, L., Ubals, M., Temprana-Salvador, J., Aparicio, G., Chicharro, C., Serre-Delcor, N., and Ferrer, B. (2021). Changes in the microbiological diagnosis and epidemiology of cutaneous leishmaniasis in real-time PCR era: A six-year experience in a referral center in Barcelona. PLoS Negl. Trop. Dis., 15.","DOI":"10.1371\/journal.pntd.0009884"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e202","DOI":"10.1093\/cid\/ciw670","article-title":"Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)","volume":"63","author":"Aronson","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"196","DOI":"10.4103\/1995-7645.345944","article-title":"New developments in the treatment of cutaneous leishmaniasis","volume":"15","author":"Dinc","year":"2022","journal-title":"Asian Pac. J. Trop. Med."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Bosch-Nicolau, P., Ubals, M., Salvador, F., S\u00e1nchez-Montalv\u00e1, A., Aparicio, G., Erra, A., Martinez de Salazar, P., Sulleiro, E., and Molina, I. (2019). Leishmaniasis and tumor necrosis factor alpha antagonists in the Mediterranean basin. A switch in clinical expression. PLoS Negl. Trop. Dis., 13.","DOI":"10.1371\/journal.pntd.0007708"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Galluzzi, L., Ceccarelli, M., Diotallevi, A., Menotta, M., and Magnani, M. (2018). Real-time PCR applications for diagnosis of leishmaniasis. Parasites Vectors, 11.","DOI":"10.1186\/s13071-018-2859-8"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"526","DOI":"10.1128\/JCM.01954-16","article-title":"Field Validation of SYBR Green- and TaqMan-Based Real-Time PCR Using Biopsy and Swab Samples to Diagnose American Tegumentary Leishmaniasis in an Area Where Leishmania (Viannia) braziliensis Is Endemic","volume":"55","author":"Gomes","year":"2017","journal-title":"J. Clin. Microbiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1891","DOI":"10.1017\/S0031182014001280","article-title":"Sensitive diagnosis of cutaneous leishmaniasis by lesion swab sampling coupled to qPCR","volume":"141","author":"Adams","year":"2014","journal-title":"Parasitology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1999","DOI":"10.1111\/jdv.15034","article-title":"Comparison of PCR-based methods for the diagnosis of cutaneous leishmaniasis in two different epidemiological scenarios: Spain and Morocco","volume":"32","author":"Tercedor","year":"2018","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1016\/S0001-706X(01)00215-7","article-title":"Usefulness of sampling with cotton swab for PCR-diagnosis of cutaneous leishmaniasis in the New World","volume":"81","author":"Mimori","year":"2002","journal-title":"Acta Trop."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Bamorovat, M., Sharifi, I., Aflatoonian, M.R., Sharifi, H., Karamoozian, A., Sharifi, F., Khosravi, A., and Hassanzadeh, S. (2018). Risk factors for anthroponotic cutaneous leishmaniasis in unresponsive and responsive patients in a major focus, southeast of Iran. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0192236"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"52","DOI":"10.4269\/ajtmh.2009.81.52","article-title":"Relapsing cutaneous leishmaniasis in a patient with ankylosing spondylitis treated with infliximab","volume":"81","author":"Mueller","year":"2009","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Darcis, G., Van der Auwera, G., Giot, J.B., Hayette, M.P., Tassin, F., Arrese Estrada, J., Cnops, L., Moutschen, M., de Leval, L., and Leonard, P. (2017). Recurrence of visceral and muco-cutaneous leishmaniasis in a patient under immunosuppressive therapy. BMC Infect. Dis., 17.","DOI":"10.1186\/s12879-017-2571-x"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Eggers, Y., Holtfreter, M., M\u00fcller-Stoever, I., Mischlinger, J., Hammacher, A., Hemmerlein, B., Kreuter, A., Oellig, F., Tappe, D., and Luedde, T. (2025). A rare case of lingual mucosal leishmaniasis caused by reactivation of Leishmania infantum infection. BMC Infect. Dis., 25.","DOI":"10.1186\/s12879-025-10592-4"},{"key":"ref_27","first-page":"314","article-title":"Misdiagnosis of cutaneous leishmaniasis and recurrence after surgical excision","volume":"160","author":"Bailey","year":"2014","journal-title":"BMJ Mil. Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1046\/j.1365-2133.1999.03215.x","article-title":"Reactivation of cutaneous leishmaniasis after surgery","volume":"141","author":"Czechowicz","year":"1999","journal-title":"Br. J. Dermatol."}],"container-title":["Infectious Disease Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2036-7449\/17\/5\/125\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:50:24Z","timestamp":1760035824000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2036-7449\/17\/5\/125"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,8]]},"references-count":28,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,10]]}},"alternative-id":["idr17050125"],"URL":"https:\/\/doi.org\/10.3390\/idr17050125","relation":{},"ISSN":["2036-7449"],"issn-type":[{"value":"2036-7449","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,8]]}}}