{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T23:18:20Z","timestamp":1790983100694,"version":"4.1.0"},"reference-count":21,"publisher":"American Society of Tropical Medicine and Hygiene","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,15]]},"abstract":"<jats:title>ABSTRACT.<\/jats:title>\n                  <jats:p>\n                    Cutaneous leishmaniasis is a neglected vector-borne disease caused by\n                    <jats:italic>Leishmania<\/jats:italic>\n                    spp., with viable parasites potentially persisting after clinical cure. Immunosuppressive therapies may favor reactivation of latent infection. The case of a 62-year-old Brazilian woman with a 25-year history of rheumatoid arthritis who developed a painful ulcerative lesion on her right leg 1 month after initiating tocilizumab therapy is reported. Molecular testing confirmed\n                    <jats:italic>Leishmania (Viannia) braziliensis<\/jats:italic>\n                    , consistent with reactivated cutaneous leishmaniasis. Tocilizumab was discontinued, and liposomal amphotericin B was initiated but interrupted because of nephrotoxicity and hepatotoxicity. Despite incomplete treatment, the lesion gradually healed after withdrawal of immunosuppression without requiring additional antiparasitic therapy. Secondary prophylaxis with liposomal amphotericin B was subsequently initiated under close clinical and laboratory monitoring, and no recurrence has been observed during follow-up. This case highlights the importance of screening clinical history for prior leishmaniasis, maintaining vigilance for reactivation in patients from endemic areas, and promptly adjusting immunosuppressive therapy to optimize clinical outcomes.\n                  <\/jats:p>","DOI":"10.4269\/ajtmh.26-0345","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T19:08:27Z","timestamp":1789499307000},"source":"Crossref","is-referenced-by-count":1,"title":["Reactivation of Cutaneous Leishmaniasis in a Rheumatoid Arthritis Patient Undergoing Tocilizumab Treatment"],"prefix":"10.4269","author":[{"given":"Regina Maia","family":"de Souza","sequence":"first","affiliation":[{"name":"Laborat\u00f3rio de Parasitologia, S\u00e3o Paulo, Universidade de S\u00e3o Paulo Instituto de Medicina Tropical de S\u00e3o Paulo, S\u00e3o Paulo, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe Francisco","family":"Tuon","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Doen\u00e7as Infecciosas e Emergentes, Pontif\u00edcia Universidade Cat\u00f3lica do Paran\u00e1, Curitiba, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ant\u00f4nio Carlos","family":"Nicodemo","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina, Departamento de Infectologia e Medicina Tropical, S\u00e3o Paulo, Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christini Takemi","family":"Emori","sequence":"additional","affiliation":[{"name":"Faculdade de Medicina, Departamento de Infectologia e Medicina Tropical, S\u00e3o Paulo, Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz Julieta","family":"Celeste","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Soroepidemiologia, S\u00e3o Paulo, Universidade de S\u00e3o Paulo Instituto de Medicina Tropical de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Carmen","family":"Arroyo Sanchez","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Soroepidemiologia, S\u00e3o Paulo, Universidade de S\u00e3o Paulo Instituto de Medicina Tropical de S\u00e3o Paulo, S\u00e3o Paulo, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valdir Sabbaga","family":"Amato","sequence":"additional","affiliation":[{"name":"Laborat\u00f3rio de Parasitologia, S\u00e3o Paulo, Universidade de S\u00e3o Paulo Instituto de Medicina Tropical de S\u00e3o Paulo, S\u00e3o Paulo, Brazil;"},{"name":"Faculdade de Medicina, Departamento de Infectologia e Medicina Tropical, S\u00e3o Paulo, Universidade de S\u00e3o Paulo, S\u00e3o Paulo, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2795","reference":[{"key":"b1","article-title":"Leishmaniasis.","year":"2021"},{"issue":"1","key":"b2","series-title":"Am J Trop Med Hyg","first-page":"81","article-title":"Reactivation of mucosal and cutaneous leishmaniasis in a renal transplanted patient","volume":"91","author":"Tuon","year":"2014"},{"issue":"3","key":"b3","series-title":"Rev Assoc Med Bras (1992)","first-page":"281","article-title":"Human leishmaniasis in Brazil: A general review","volume":"64","author":"Anversa","year":"2018"},{"issue":"2","key":"b4","series-title":"Rev Bras Reumatol","first-page":"158","article-title":"Guidelines for the drug treatment of rheumatoid arthritis","volume":"53","author":"Mota","year":"2013"},{"key":"b5","series-title":"Rheumatology (Oxford)","first-page":"v3","article-title":"Understanding the dynamics: Pathways involved in the pathogenesis of rheumatoid 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