02166nas a2200373   4500000000100000008004100001260001300042653002700055653002600082653001100108653002900119653001500148653002400163653002300187653002400210653000900234653001600243653002500259653003100284653002900315653001400344653003200358100001600390700002000406700001300426700002400439700001500463700001800478245009400496300001100590490000700601520117000608022001401778       2011                            d  c2011 Aug10aAntibodies, Monoclonal10aAntitubercular Agents10aHumans10aImmunosuppressive Agents10aInfliximab10aLatent Tuberculosis10aLeprostatic Agents10aLeprosy, Borderline10aMale10aMiddle Aged10aMycobacterium leprae10aMycobacterium tuberculosis10aOpportunistic Infections10aPsoriasis10aTumor Necrosis Factor-alpha1 aTeixeira FM1 aVasconcelos LMF1 aRola CAD1 aPrata de Almeida TL1 aValenca JT1 aNagao-Dias AT00aSecondary leprosy infection in a patient with psoriasis during treatment with infliximab.  a269-710 v173 a<p>Tumor necrosis factor α antagonists are proven to be effective for the treatment of chronic inflammatory conditions, such as psoriasis. A major concern for patients is the risk of acquiring granulomatous infectious diseases caused by the immunosuppressive effects of the drugs. We report a 60-year-old man with psoriasis who underwent infliximab treatment for 2 years and developed secondary leprosy, presenting extensive erythematous and infiltrated plaques on the trunk and limbs with loss of sensitivity (thermal, pain and tactile). The skin lesion biopsy showed perivascular epithelioid granulomas, nodular dermal aggregates of foamy macrophages and bundles of acid-fast bacilli. The clinical picture associated with histopathologic evaluation suggested borderline lepromatous leprosy. Before infliximab treatment, the patient had a positive tuberculin skin test and underwent chemoprophylaxis treatment for latent tuberculosis. Although the tuberculin reactivity suggests a strong correlation with a latent Mycobacterium tuberculosis infection, the possibility of infections by other mycobacteria, such as Mycobacterium leprae, should not be discarded.</p>  a1536-7355