Evolution of cutaneous leishmaniasis in the last 30 years in a tertiary hospital of the European Mediterranean coast.

BACKGROUND: Although with a lower incidence than in other geographic areas, leishmaniasis is also endemic on the European Mediterranean coast. However, there are few studies on the clinical features of cutaneous lesions of leishmaniasis in Europe. Our objective was to review the clinical features of cutaneous leishmanial lesions in our European Mediterranean population in the last 30 years and compare the clinical features of immunosuppressed and nonimmunosuppressed patients.
METHODS: The clinical features of cutaneous lesions of leishmaniasis diagnosed between 1987 and 2016 at Bellvitge Hospital in Barcelona, Spain, were retrospectively analyzed.
RESULTS: Cutaneous lesions of leishmaniasis were diagnosed in 68 patients (40 male and 28 female, mean age 53.60 years, SD 19.68). Thirteen patients were immunosuppressed because of acquired immune deficiency syndrome (AIDS) (7), renal transplantation (1), lymphoma (1), and anti-TNF agents (4). Our immunosuppressed patients had more lesions (3.33 vs. 1.80, P = 0.021), with greater maximum diameter (33.00 vs. 13.33 mm, P = 0.001), and their lesions were more frequently disseminated (P = 0.008). Visceral leishmaniasis was observed only in immunosuppressed patients. Patients treated with anti-TNF drugs developed unusually large skin lesions with crusted, eroded surfaces and without a tendency to spontaneous remission.
CONCLUSION: With the widespread use of anti-TNF agents, an increase in severe forms of leishmaniasis can be expected. The development of persistent, crusted, or eroded erythematous-brownish plaques in patients treated with anti-TNF drugs who live or had traveled to endemic areas of Leishmania infection warrants consideration of a diagnosis of cutaneous leishmaniasis.