case_images: PMC5958277_01
case_images: Clinical presentation. (A) Erythematous plaque on the nose and (B) skin biopsy showing vacuolated macrophages with abundant parasites (HE, 400x).
case_images: fimmu-09-01021-g001.jpg
case_images: PMC5958277_01_fimmu-09-01021-g001.jpg
case_images: F1
case_images: A male 65-year-old resident of Brasilia, Federal District, Brazil, presented with an erythematous plaque on his nose one month after fishing in the state of Amazonas, Brazil (Figure 1).
case_images: Cellular viability of total peripheral blood mononuclear cells (PBMCs) after SLA stimulation. The patient's total PBMCs were stained with Annexin V and propidium iodide. Medium (M), soluble Leishmania amazonensis antigen (10 microg/mL SLA), and concanavalin A (15 microg/mL conA) after 48 h of in vitro restimulation.
case_images: fimmu-09-01021-g002.jpg
case_images: PMC5958277_01_fimmu-09-01021-g002.jpg
case_images: F2
case_images: The in vitro experiments showed that the cells were viable, and no differences in the cell death markers were found between the SLA-treated cells and negative controls (unstimulated) (Figure 2).
case_images: Programmed death ligand 1 (PD-L1) expression in monocytes is increased after SLA restimulation. The patient's total Peripheral blood mononuclear cells were stained with anti-PD-L1 antibody. PD-L1 expression was analyzed in a population of monocytes gated by size (FSC) and granularity (SSC). Medium (M), soluble Leishmania amazonensis antigen (10 microg/mL SLA), and concanavalin A (15 microg/mL conA) after 48 h of in vitro restimulation.
case_images: fimmu-09-01021-g003.jpg
case_images: PMC5958277_01_fimmu-09-01021-g003.jpg
case_images: F3
case_images: We observed an increase in the expression of the inhibitory molecule PD-L1 in the monocytes restimulated in vitro with SLA (approximately 65%), whereas the negative controls were 35% positive for PD-L1 (Figure 3).
case_images: SLA decreased IFN-gamma production by CD4+ cells and IFN-gamma/granzyme B production by CD8+ T cells. The patient's total peripheral blood mononuclear cells were stained with anti-CD4, anti-CD8, anti-IFN-gamma and anti-granzyme B antibodies. (A) Lymphocytes were gated by size (FSC) and granularity (SSC), and IFN-gamma was analyzed in a CD4+ population. (B) IFN-gamma or granzyme B expression was analyzed in a CD8+ population. Medium (M), soluble L. amazonensis antigen (10 microg/mL SLA), and concanavalin A (15 microg/mL conA) after 48 h of in vitro restimulation.
case_images: fimmu-09-01021-g004.jpg
case_images: PMC5958277_01_fimmu-09-01021-g004.jpg
case_images: F4
case_images: We also observed a relevant decrease in granzyme B expression in CD8+ T cells, from 31% in the negative controls to 5% after SLA restimulation (Figure 4).