LEISHMANIASIS REACTIVATION DURING TREATMENT OF CHRONIC HEPATITIS B WITH INTERFERON ALPHA 2B

Abstract

We describe a case of reactivation of mucocutaneous leishmaniasis during treatment with interferon alpha 2b (IFN) for chronic hepatitis B (HBV). Case report: male patient, 52 years old, born in Bahia and living in São Paulo for 30 years. The patient was referred for HBV. Epidemiological history: he reported a trip to Porto Seguro-BA 5 years ago without other risk factors. There was no evidence of chronic liver disease at admission. Serology pretreatment: HBsAg and HBeAg positive, biopsy A0F0 (Metavir). 5 million IU IFN/day for 24 weeks was applied. Subsequently he had detectable HBV DNA without HBeAg seroconversion in the end. He developed 10 kg weight loss, weakness, signs and symptoms of sinusitis without improvement after antibiotic therapy in the fourth month of treatment. He was referred to otolaryngology with persistent hoarseness, destruction of the nasal septum with areas of scabs, necrosis, nasal enlargement and injury to the soft palate. The lesion biopsy showed granulomatous inflammatory process with caseous necrosis, indicating leishmaniasis. Serology for leishmaniasis was IgG 1/80 (IFI) and Montenegro test 30 mm. Meglumine antimoniate IV was prescribed for 30 days. Conclusion: The clinical presentation suggests reactivation of leishmaniasis induced by IFN. It is believed that this is the first reported case in the literature of reactivation of mucocutaneous leishmaniasis by IFN and the mechanism could be similar to that seen in tuberculosis. Screening for leishmaniasis ought to be conducted in endemic regions before treatment with IFN due to the possibility of reactivation of latent infection.