SAT0402 Leishmaniasis in patients on tumour necrosis factor inhibitors treatment

Abstract

BackgroundTumour necrosis factor (TNF) plays a major role in defense against leishmaniasis. Despite wide use of TNFα inhibitor (anti-TNF) for several diseases, leishmaniasis has been a rare infectious complication so far in these patients. Recently, an increased incidence has been noted.ObjectivesTo describe a recent multicenter case series of leishmaniasis in patients with chronic inflammatory diseases treated with anti-TNF.MethodsWe reviewed the clinical history of a multicentric series of patients with chronic inflammatory diseases treated with anti-TNF, who were diagnosed with leishmaniasis between January 2013 and December 2017. Patients came from Rheumatology, Digestive and Dermatology departments of several hospitals in Valencia2 and Cataluña1 region. Demographic (age, sex) and clinical (inflammatory disease, comorbidities, current treatment, year of infection and leishmaniasis form) variables were collected. Anti-TNF withdraw, subsequent reintroduction and recurrence rate were recorded in two hospitals. Biologic drug dispensation trends from 2013 to 2016 and epidemiological data published by the Regional Ministry of Health of Valencia for the area where cases were most incident were analysed.Results25 cases of leishmaniasis in patients treated with immunomodulators were identified:7 on DMARD, 1 on tocilizumab and 17 on anti-TNF (7 infliximab, 4 adalimumab, 3 golimumab, 2 certolizumab, 1 etanercept). Regarding patients on anti-TNF, 2 cases were collected in 2014, 4 in 2015, 4 in 2016 and 7 in 2017. Three patients developed the visceral form, 13 the cutaneous form and 1 presented visceral and cutaneous involvement. Seven patients were males and 10 females, with an average age of 50 (SD14) years. One patient presented rheumatoid arthritis, 4 psoriatic arthritis, 1 undifferentiated spondyloarthropathy, 2 ankylosing spondylitis, 1 uveitis, 6 Crohn’s disease and 2 ulcerative colitis. Six patients presented other chronic disease (1 latent tuberculosis, 1 pyoderma gangrenosum, 1 psoriasis and 3 diabetes mellitus). In two hospitals (15 patients), anti-TNF treatment was withdrawn in 10 cases, and it was reintroduced after treating the infection in 5 cases. No infection recurrences have been indentified. Focusing on the area with the highest incidence of cases, despite the increase in anti-TNF use over the last years, its consumption was not parallel to the rise of leishmaniasis cases reported.Conclusionsthe disproportionate increase of leishmaniasis cases in patients with anti-TNF suggests the necessity to investigate and control other possible factors involved.Disclosure of InterestNone declared