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Patients coinfected with Leishmania/HIV can develop atypical forms of visceral leishmaniasis (VL), making it indispensable to identify the etiological agent. We are presenting a postmortemspecie definition by ITS1-PCR-RFLP in a larynx tissue of a patient presented coinfectionLeishmania/HIV. This patient was from a leishmaniasis endemic region in São Paulo(SP), Brazil, and was diagnosed clinically with mucocutaneous leishmaniasis. Before a rK39immunochromatographic test positive, a tiny stored paraffin-embedded larynx tissue wasobtained post-mortem and submitted to 3 conventional PCR assays: kDNA (K20/K22 and RV1/RV2), and ITS1 (LITSR/ L5.8S). The last one was followed by RFLP (HaeIII) andanalyzed by 4% Metaphor agarose gel electrophoresis. Leishmania genus and Leishmania(Leishmania) subgenus were defined by kDNA-PCR, with K20/K22 (120 bp) and RV1/RV2(145 bp), respectively. ITS1-PCR-RFLP identified L. (L.) infantum chagasi species visualizedby the restriction patterns of 180, 70 and 50 bp. This case draws attention to the necessityfor a clear identification of the etiological agent causing infection, especially in endemicregions of cutaneous and visceral leishmaniasis, and particularly in patients with comorbidities who often present atypical forms of the disease. L. (L.) infantum chagasi, which is usuallyresponsible for VL, had changed its clinical spectrum for mucocutaneous. Unequivocalidentification was carried out by ITS-PCR-RFLP, therefore confirming rK39 result. Thesetechniques, which complemented each other, have a convenient cost-benefit ratio thatmakes them suitable to be applied in developing countries.

Rheumatoid arthritis (RA) is a chronic condition that is frequent in patients living in tropical areas exposed to leishmaniasis. RA therapy involves immunosuppressant drugs such as methotrexate (MTX), monoclonal antibodies (mAbs) and prednisone. We report an unusual presentation of cutaneous (CL) or mucocutaneous leishmaniasis (ML) in RA patients from an endemic area of leishmaniasis. A 51-year-old woman noted a cutaneous ulcer on her left ankle during MTX and prednisone RA therapy. Initially diagnosed as a venous stasis ulcer, the aspirate of the injury revealed the presence of Leishmania DNA. A 73-year-old woman presenting non-ulcerated, infiltrated and painful erythematous nodules inside her nostrils while receiving MTX, anti-TNF mAb, and prednisone for RA, had also the aspirate of injuries showing the presence of Leishmania DNA. Both patients healed after the therapy with liposomal amphotericin. The RA therapy has changed to low-dose prednisone, without further reactivation episodes. Both cases suggest that CL or ML can reactivate after administration of an immunosuppressant for RA treatment. Therefore, immunosuppressive treatments for RA should be carefully prescribed in patients from endemic areas or with a history of CL and ML. [ABSTRACT FROM AUTHOR]