RESUMO
Erythroderma consists of erythema and scaling involving most or all of the body surface. This generalized eruption may be idiopathic, drug-induced or secondary to cutaneous or systemic disease. A 71-year-old man is reported presenting generalized erythema and desquamation with deck-chair sign, nail dystrophy, and plantar ulcers associated with loss of local tactile sensitivity. Biopsies from three different sites demonstrated diffuse lymphocytic infiltrate with incipient granulomas. Fite-Faraco staining showed numerous isolated bacilli and globi. The skin smear was positive. Clinical and pathological diagnosis of borderline lepromatous leprosy was confirmed. This report demonstrates that chronic multibacillary leprosy can manifest as erythroderma and thus should be included in the differential diagnosis.
Assuntos
Dermatite Esfoliativa/complicações , Hanseníase Dimorfa/etiologia , Hanseníase Virchowiana/etiologia , Idoso , Biópsia , Dermatite Esfoliativa/diagnóstico , Dermatite Esfoliativa/patologia , Diagnóstico Diferencial , Humanos , Hanseníase Dimorfa/diagnóstico , Hanseníase Dimorfa/patologia , Hanseníase Virchowiana/diagnóstico , Hanseníase Virchowiana/patologia , MasculinoRESUMO
Abstract: Erythroderma consists of erythema and scaling involving most or all of the body surface. This generalized eruption may be idiopathic, drug-induced or secondary to cutaneous or systemic disease. A 71-year-old man is reported presenting generalized erythema and desquamation with deck-chair sign, nail dystrophy, and plantar ulcers associated with loss of local tactile sensitivity. Biopsies from three different sites demonstrated diffuse lymphocytic infiltrate with incipient granulomas. Fite-Faraco staining showed numerous isolated bacilli and globi. The skin smear was positive. Clinical and pathological diagnosis of borderline lepromatous leprosy was confirmed. This report demonstrates that chronic multibacillary leprosy can manifest as erythroderma and thus should be included in the differential diagnosis.
Assuntos
Humanos , Masculino , Idoso , Hanseníase Dimorfa/etiologia , Hanseníase Virchowiana/etiologia , Dermatite Esfoliativa/complicações , Biópsia , Hanseníase Dimorfa/diagnóstico , Hanseníase Dimorfa/patologia , Hanseníase Virchowiana/diagnóstico , Hanseníase Virchowiana/patologia , Dermatite Esfoliativa/diagnóstico , Dermatite Esfoliativa/patologia , Diagnóstico DiferencialAssuntos
Humanos , Feminino , Pré-Escolar , Hanseníase Dimorfa/diagnóstico , Hanseníase Dimorfa/etiologiaRESUMO
The transmission of leprosy has been universally accepted to be primarily, through nasal dissemination from multibacillary patients to the susceptible persons. However, the possibility of leprosy transmission through prolonged skin contact with abraded leprous skin or through skin inoculation can not be ruled out. We report a case of development of a paucibacillary leprosy patch close to the site of a local trauma, after an interval of about 13-14 years, in a HIV positive subject. Also discussed are the various hypotheses in the aetiopathogenesis of leprosy like entry route of lepra bacilli into the body, viability of lepra bacilli in the environment and evolution of skin and nerve lesions of leprosy.
Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Infecções por HIV/tratamento farmacológico , HIV-1 , Síndrome Inflamatória da Reconstituição Imune/induzido quimicamente , Hanseníase Dimorfa/etiologia , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções por HIV/complicações , Infecções por HIV/imunologia , Humanos , Hanseníase Dimorfa/imunologia , Hanseníase Dimorfa/patologia , Masculino , Pessoa de Meia-Idade , Pele/patologiaAssuntos
Hanseníase/epidemiologia , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Feminino , Hospitais Pediátricos , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Hanseníase/etiologia , Hanseníase/patologia , Hanseníase/prevenção & controle , Hanseníase Dimorfa/epidemiologia , Hanseníase Dimorfa/etiologia , Hanseníase Dimorfa/patologia , Hanseníase Dimorfa/prevenção & controle , Hanseníase Virchowiana/epidemiologia , Hanseníase Virchowiana/etiologia , Hanseníase Virchowiana/patologia , Hanseníase Virchowiana/prevenção & controle , Masculino , Índice de Gravidade de Doença , Distribuição por SexoRESUMO
The effect of solid-organ transplantation on the acquisition, presentation and course of leprosy is unknown. We present a case of leprosy in a heart transplant recipient with multiple unique features possibly attributed to altered immune function.
Assuntos
Transplante de Coração/efeitos adversos , Hanseníase Dimorfa/etiologia , Hanseníase Virchowiana/etiologia , Idoso , Criptosporidiose/etiologia , Infecções por Citomegalovirus/etiologia , Rejeição de Enxerto/tratamento farmacológico , Humanos , Terapia de Imunossupressão/efeitos adversos , Hansenostáticos/uso terapêutico , Hanseníase Dimorfa/imunologia , Hanseníase Dimorfa/microbiologia , Hanseníase Dimorfa/patologia , Hanseníase Virchowiana/imunologia , Hanseníase Virchowiana/microbiologia , Hanseníase Virchowiana/patologia , Masculino , Mycobacterium tuberculosis/isolamento & purificaçãoRESUMO
Humanized monoclonal antibodies to tumor necrosis factor- alpha are valuable for the treatment of rheumatologic conditions, but they have been associated with the development of serious infections. We report the first 2 cases of leprosy developing after treatment with infliximab. After discontinuation of infliximab, both patients developed type 1 ("reversal") leprosy reactions.
Assuntos
Anticorpos Monoclonais/efeitos adversos , Antirreumáticos/efeitos adversos , Artrite/tratamento farmacológico , Hanseníase Dimorfa/etiologia , Idoso , Anticorpos Monoclonais/imunologia , Anticorpos Monoclonais/uso terapêutico , Antirreumáticos/imunologia , Antirreumáticos/uso terapêutico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Infliximab , Hansenostáticos/uso terapêutico , Hanseníase Dimorfa/induzido quimicamente , Hanseníase Dimorfa/microbiologia , Masculino , Pessoa de Meia-Idade , Fator de Necrose Tumoral alfa/antagonistas & inibidoresRESUMO
Erythema nodosum leprosum (ENL) or type 2 lepra reactions complicate lepromatous leprosy and borderline lepromatous leprosy. We report an 11-year retrospective case record analysis of 481 outpatients with borderline lepromatous and lepromatous leprosy at the Dhoolpet Leprosy Research Center in Hyderabad, India.. The overall prevalence of ENL was 24%, 49.4% among cases of lepromatous leprosy (LL) and 9% among cases of borderline lepromatous (BL) leprosy. Logistic regression analysis identified LL (odds ratio [OR] = 8.4, 95% confidence interval [CI] = 4.6-15.4, P < 0.001) and BL with a bacterial index > or = 4+ (OR = 5.2, 95% CI = 2.1-12.9, P = 0.001) as major risk factors. The average patient with ENL was male, 34.7 years of age, and had multiple episodes of ENL (mean = 3.1) over an 18.5-month period. Three types of ENL were identified: single acute ENL, multiple acute ENL (repeated discrete episodes), and chronic ENL (continuous episodes). Acute single ENL is rare, accounting for only 8% of cases. Chronic ENL accounted for 62.5% of the cohort. Chronic ENL was of longer duration and more severe. An age > or = 35 years was a risk factor for developing chronic ENL. Patients with chronic ENL were more compliant with multi-drug therapy, especially during the first six doses of multi-drug therapy. Distinguishing these different types of ENL would be useful for patient management and developing improved treatment of these debilitating reactions. Improved strategies for treatment and management of these reactions need to be developed.
Assuntos
Eritema Nodoso/epidemiologia , Hanseníase Dimorfa/epidemiologia , Hanseníase Virchowiana/epidemiologia , Adulto , Estudos de Coortes , Eritema Nodoso/etiologia , Eritema Nodoso/patologia , Eritema Nodoso/prevenção & controle , Feminino , Humanos , Índia/epidemiologia , Hanseníase Dimorfa/etiologia , Hanseníase Dimorfa/patologia , Hanseníase Dimorfa/prevenção & controle , Hanseníase Virchowiana/etiologia , Hanseníase Virchowiana/patologia , Hanseníase Virchowiana/prevenção & controle , Modelos Logísticos , Masculino , Prontuários Médicos , Prevalência , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de DoençaRESUMO
We describe the case of a 4-year-old boy, with a positive family history of multibacillary leprosy (borderline-borderline) in his 12-year-old sister. The patient was diagnosed to have borderline lepromatous (BL) leprosy, BI of 4 + and had two erythematous, infiltrated plaques over the scrotum. He developed type reaction, 3 months following initiation of multibacillary multidrug therapy (MB-MDT) and responded favourably to systemic corticosteroids.
Assuntos
Doenças dos Genitais Masculinos/etiologia , Hansenostáticos/efeitos adversos , Hanseníase Dimorfa/tratamento farmacológico , Corticosteroides/uso terapêutico , Pré-Escolar , Quimioterapia Combinada , Humanos , Hansenostáticos/uso terapêutico , Hanseníase Dimorfa/etiologia , Masculino , Prednisolona/uso terapêutico , EscrotoRESUMO
Hansen's disease, leprosy, is a chronic infectious disease caused by the acid-fast bacillus Mycobacterium leprae. There are multiple forms of the disease ranging from the relatively benign to the progressive, malignant lepromatous leprosy. There is effective antimicrobial treatment available that is capable of curing the disease. We report the case of a post heart transplant patient acquiring Hansen's disease.
Assuntos
Transplante de Coração/efeitos adversos , Hanseníase Dimorfa/etiologia , Hanseníase Virchowiana/etiologia , Animais , Tatus/microbiologia , Biópsia , Cardiomiopatia Dilatada/complicações , Dapsona/uso terapêutico , Vetores de Doenças , Cães/microbiologia , Quimioterapia Combinada , Etionamida/uso terapêutico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/cirurgia , Transplante de Coração/imunologia , Humanos , Imunossupressores/efeitos adversos , Hansenostáticos/uso terapêutico , Hanseníase Dimorfa/diagnóstico , Hanseníase Dimorfa/tratamento farmacológico , Hanseníase Dimorfa/transmissão , Hanseníase Virchowiana/diagnóstico , Hanseníase Virchowiana/tratamento farmacológico , Hanseníase Virchowiana/transmissão , Masculino , Pessoa de Meia-Idade , Minociclina/uso terapêutico , Encaminhamento e ConsultaRESUMO
The relationship between leprosy and psoriasis has been controversial since ancient times. Based on the fundamental importance of nerve involvement in the pathogenesis of leprosy and psoriasis, it has been hypothesized that leprosy patients may be protected from developing psoriasis. There are only sporadic reports of coexistence of these two diseases as evidence of this negative association. We report a 64-year-old male patient with borderline leprosy and psoriasis. Recent advances in the elucidation of pathogenesis of both diseases have contributed to the understanding of this enigmatic relationship. Various genetic, immunological, and structural alterations in leprosy and psoriasis as discussed could be responsible for the rare co-existence of these two diseases in a given patient.
Assuntos
Hanseníase Dimorfa/complicações , Psoríase/complicações , Humanos , Hanseníase Dimorfa/etiologia , Hanseníase Dimorfa/patologia , Masculino , Pessoa de Meia-Idade , Psoríase/etiologia , Psoríase/patologiaRESUMO
Hansen's disease (leprosy) is rare in Australia and usually imported from endemic areas. We report a 23-year-old white male with multibacillary leprosy who had lived all his life in North Queensland and initially appeared to have no risk factors. However, historical records revealed his grandfather to have been infected; because of stigma, this was unknown to the patient. As Hansen's disease has an incubation period of years, isolated cases may still occur as a result of previous endemicity in Queensland.
Assuntos
Família , Hanseníase Dimorfa/etiologia , Hanseníase Dimorfa/transmissão , Adulto , Biópsia , Diagnóstico Diferencial , Humanos , Hanseníase Dimorfa/diagnóstico , Hanseníase Dimorfa/tratamento farmacológico , Masculino , Queensland , Características de Residência , Fatores de RiscoRESUMO
A cohort of new borderline leprosy patients seen over a 7-year period were examined retrospectively for risk of type 1 reactions (T1R) associated with 12 clinical and laboratory parameters. Logistic regression analysis was used to identify a strong link between facial patches and cutaneous T1R and enlarged ulnar nerves and neural T1R. Anti-phenolic glycolipid-I seropositivity, a positive bacterial index, and disease in more than two body areas were also identified as risk factors for T1R. These data indicate that there are important clinical data which can be used to predict an individual patient's risk of developing T1R.
Assuntos
Hanseníase Dimorfa/diagnóstico , Hanseníase Dimorfa/etiologia , Hanseníase Dimorfa/patologiaRESUMO
A cohort of new borderline leprosy patients seen over a 7-year period were examined retrospectively for risk of type 1 reactions (T1R) associated with 12 clinical and laboratory parameters. Logistic regression analysis was used to identify a strong link between facial patches and cutaneous T1R and enlarged ulnar nerves and neural T1R. Anti-phenolic glycolipid-I seropositivity, a positive bacterial index, and disease in more than two body areas were also identified as risk factors for T1R. These data indicate that there are important clinical data which can be used to predict an individual patient's risk of developing T1R.
Assuntos
Antígenos de Bactérias , Hanseníase Dimorfa/patologia , Adolescente , Adulto , Idoso , Anticorpos Antibacterianos/análise , Anticorpos Antibacterianos/imunologia , Criança , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/microbiologia , Feminino , Glicolipídeos/imunologia , Humanos , Hanseníase Dimorfa/diagnóstico , Hanseníase Dimorfa/etiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Retrospectivos , Fatores de Risco , Pele/patologia , Nervo Ulnar/patologiaRESUMO
The effect of BCG on the risk of leprosy was measured using a case-control design in an area endemic for the disease. In this study, 397 newly diagnosed cases and 669 controls matched for age, sex and locality were selected from a defined population. Information on exposure to BCG, contact with another case of leprosy, and relevant socioeconomic variables were obtained from the subjects. Having infectious (multibacillary) and noninfectious (paucibacillary) contacts in the household increased the risk of disease 11.7 times (p less than 0.001) and 2.7 times (p less than 0.001), respectively. Overall, the protection offered by BCG was not significant (odds ratio = 0.8; p = 0.17). However, BCG appeared to increase the risk for indeterminate leprosy (adjusted odds ratio = 2.7; p = 0.09) while protecting against borderline disease (adjusted odds ratio = 0.39; p = 0.03). It is possible that BCG causes a shift in the overall cell-mediated immune response, thus increasing the risk for milder and transient forms of leprosy while protecting against more serious forms. These findings may have important implications for the design and interpretation of vaccine trials. Namely, trials should be designed to measure the protective efficacy of vaccines against the more serious forms of leprosy, which have the greatest public health significance.