Leishmaniasis in Spanish tattoos

Dear Editor:

I read with great interest the article of Garcia-Lazaro et al recently published in the Journal regarding a case of leishmaniasis occurring within a tattoo of an HIV patient.¹ They have added a new case of leishmaniasis on tattoos in HIV patients. As suggested by Lopez-Medrano et al,² this reaction is mostly likely the consequence of macrophages infection by leishmania. Macrophages tend to gather in the tattooed dermis in order to assimilate the exogenous pigments…. However, Lopez-Medrano et al stated recently³ that their case have been the second reported in the literature since 1997⁴… Unfortunately, this is not true either. Indeed, in 2002, Bosch et al, from Malaga (Spain again!), reported a case series of HIV-infected patients with visceral leishmaniasis and specific cutaneous lesions.⁵ Among them, a 46-year-old male with a T lymphocyte count of 128 cells/mm³ presented a papular and nodular infiltration of his tattoo. Granuloma and leishmania were found in the skin biopsy. Infiltrative relapses coincided with systemic worsening and the lesions disappeared after appropriate anti-Leishmaniasis treatment.⁵ They even provide a black and white clinical picture of the infiltrated tattoo that reminds us of the case of Lopez-Medrano et al. Unfortunately, there is no way to find this article on PUBMED, if you are looking specifically for tattoo reactions. Anyhow, one thing is certain: Spain currently has, to the best of my knowledge, the largest series of cutaneous tattoo reactions related to leishmania in HIV patients…