Anergy in American mucocutaneous leishmaniasis, caused by syphilis

Abstract

The author gives an account of the first known case of anergy on mucocutaneous American leishmaniosis, provoked by syphilis. The patient had both ulceration and infiltration of the face clinically characteristic of leishmaniosis and positive leishmania smears. Montenegro's intradermic test (killed leishmania cultures employed as antigens) was several times negative. Previously the patient had contracted syphilis which was improperly treated. His Wassermann and Kahn tests were strongly positive (+ +++) when he carne under our care. After 45 days of simultaneous treatment against both diseases by bismuth iodide and "Eparseno" (Rhodia), the following evolution was observed: the leishmania lesions were greatly improved and Montenegro's test became strongly positive (+ + + +) while tests for syphilis on blood serum were only slightly positive (+). This observation is particularly interesting for those cases, undoubtedly rare, which have clinical and microbiological positive diagnosis for leishmaniosis but which have immunological negative tests (Montenegro's intradermic test). This observation throws light on the fact brought out by some observers, that intradermic tests for leishmaniosis, occasionally, are negative in clinical and microbiologically positive cases of American mucocutaneous leishmaniosis.