RESUMO
Leprosy was eliminated globally in 2000, but it continues to be endemic in developing countries like India, Brazil and Indonesia, with a prevalence of 0.57/10 000 persons in India (2020). At the end of the year 2020, the prevalence was 129 389, and oral manifestation of the leprosy is luncommon. We hereby report a case of a female patient in her late 30s who presented with palatal perforation. Following a thorough history taking and full body clinical examination, we arrived at a diagnosis of leprosy, and prompt treatment was initiated. Knowledge of cases like this becomes important as the oral lesion is said to form an essential source of leprosy dissemination in the community, and awareness about them becomes crucial, demanding immediate attention.
Assuntos
Hanseníase Dimorfa , Hanseníase Virchowiana , Hanseníase Multibacilar , Hanseníase , Feminino , Humanos , Índia/epidemiologia , Hanseníase/diagnóstico , Hanseníase Dimorfa/epidemiologia , Hanseníase Dimorfa/patologia , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/diagnóstico , Hanseníase Virchowiana/tratamento farmacológico , PrevalênciaRESUMO
Reactions in leprosy represent sudden shift in the immunological response and are seen in 11-25% of affected patients. It can be seen before, during or after the completion of multidrug therapy (MDT).1 Two types of reactions are recognized; Type 1 reaction (T1R), seen in borderline leprosy, affecting mainly skin and nerves; type 2 reaction (T2R) or erythema nodosum leprosum (ENL), seen in lepromatous leprosy, characterized by systemic features in addition to cutaneous lesions. Trophic ulcers and ulcerating ENL are well known entities while cutaneous ulceration in T1R is extremely rare; we describe an immune-competent woman with cutaneous ulceration as a presenting feature to highlight the need to recognize this entity at the earliest opportunity.
Assuntos
Eritema Nodoso , Hanseníase Dimorfa , Hanseníase Virchowiana , Úlcera Cutânea , Quimioterapia Combinada , Eritema Nodoso/diagnóstico , Eritema Nodoso/tratamento farmacológico , Eritema Nodoso/etiologia , Feminino , Humanos , Hansenostáticos/uso terapêutico , Hanseníase Dimorfa/complicações , Hanseníase Dimorfa/tratamento farmacológico , Hanseníase Dimorfa/patologia , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/diagnóstico , Hanseníase Virchowiana/tratamento farmacológico , Úlcera Cutânea/diagnóstico , Úlcera Cutânea/tratamento farmacológico , Úlcera Cutânea/etiologiaAssuntos
Hanseníase Dimorfa , Síndrome de Melkersson-Rosenthal/patologia , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Hanseníase/diagnóstico , Hanseníase/patologia , Hanseníase Dimorfa/diagnóstico , Hanseníase Dimorfa/patologia , Hanseníase Paucibacilar/diagnóstico , Hanseníase Paucibacilar/patologia , Lábio/patologia , Mycobacterium leprae/isolamento & purificaçãoAssuntos
Antituberculosos/uso terapêutico , Hansenostáticos/uso terapêutico , Hanseníase Dimorfa/diagnóstico , Hanseníase Multibacilar/diagnóstico , Matadouros , Anti-Inflamatórios/uso terapêutico , Clofazimina/uso terapêutico , Dapsona/uso terapêutico , Diagnóstico Diferencial , Humanos , Isoniazida/uso terapêutico , Tuberculose Latente/complicações , Tuberculose Latente/tratamento farmacológico , Hanseníase Dimorfa/complicações , Hanseníase Dimorfa/tratamento farmacológico , Hanseníase Dimorfa/patologia , Hanseníase Multibacilar/complicações , Hanseníase Multibacilar/tratamento farmacológico , Hanseníase Multibacilar/patologia , Masculino , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Rifampina/uso terapêutico , Tromboflebite/diagnósticoRESUMO
Leprosy is a long-term spectrum disease and can present various clinical and histopathological aspects. Between the two poles of leprosy, there is a wide range of types, consisting of intermediate or borderline forms. In this chapter, the clinical, histopathological, and bacilloscopic characteristics of the intermediate forms (borderlibe-tuberculoid [BT], borderline-borderline [BB], and borderline lepromatous [BL]) are presented and discussed. The main clinical and pathological characteristics that allow the diagnosis and classification of leprosy among the different borderline forms are described and illustrated in panel form, as well as their most significant clinical and histopathological differential diagnoses are also discussed. The clinical-pathological classification of this disease has important implications in the choice of the correct treatment, the understanding of the pathophysiology, and the development of the reaction phenomena typical of leprosy,.
Assuntos
Hanseníase Dimorfa/patologia , Hanseníase Paucibacilar/patologia , Hanseníase Dimorfa/diagnóstico , Hanseníase Paucibacilar/diagnósticoAssuntos
Hanseníase Dimorfa/diagnóstico , Hanseníase Virchowiana/diagnóstico , Tinha Versicolor/diagnóstico , Biópsia , Criança , Diagnóstico Diferencial , Feminino , Humanos , Hansenostáticos/uso terapêutico , Hanseníase Dimorfa/tratamento farmacológico , Hanseníase Dimorfa/patologia , Hanseníase Virchowiana/tratamento farmacológico , Hanseníase Virchowiana/patologia , Pele/patologiaRESUMO
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 DiferencialRESUMO
INTRODUCTION: Leprosy is a chronic granulomatous disease caused by M. leprae. It is a great imitator as it can manifest in different unusual and atypical ways. Mid borderline leprosy (BB) is an unstable form representing the immunologic midpoint in the clinical spectrum. CASE REPORT: Here, we report a case of BB leprosy having classical inverted saucer-shaped lesions elsewhere on the body with a linear psoriasiform lesion over the left forearm following the lines of Blaschko. Biopsy from this lesion revealed granulomas consisting of equal admixture of epithelioid cells and macrophages without multinucleate giant cells suggesting mid borderline leprosy. CONCLUSION: Occurrence of lesions in a Blaschko linear pattern supports the role of genetic susceptibility to leprosy. The genetically vulnerable cells along the lines of Blaschko were infected while the surrounding cells remained unaffected. This explains the concept of locus minoris resistentiae due to cutaneous mosaicism.
Assuntos
Antibacterianos/uso terapêutico , Hanseníase Dimorfa/diagnóstico , Mycobacterium leprae/isolamento & purificação , Biópsia , Quimioterapia Combinada/métodos , Humanos , Hanseníase Dimorfa/tratamento farmacológico , Hanseníase Dimorfa/patologia , Masculino , Pessoa de Meia-Idade , Pele/microbiologia , Pele/patologia , Resultado do TratamentoRESUMO
Erythema nodosum leprosum (ENL) is characterized by tender erythematous nodules, accompanied by fever, malaise, arthralgia, and systemic complications. Atypical clinical manifestations have been reported such as pustular, bullous, ulceration; livedo reticularis; erythema multiforme-like reaction; and Sweet's syndrome (SS)-like presentation. We reported a case of ENL reaction presenting as SS-like reaction in a borderline lepromatous leprosy patient.
Assuntos
Eritema Nodoso/diagnóstico , Hanseníase Dimorfa/diagnóstico , Hanseníase Virchowiana/diagnóstico , Síndrome de Sweet/diagnóstico , Adulto , Eritema Nodoso/microbiologia , Eritema Nodoso/patologia , Humanos , Hanseníase Dimorfa/microbiologia , Hanseníase Dimorfa/patologia , Hanseníase Virchowiana/microbiologia , Hanseníase Virchowiana/patologia , Masculino , Mycobacterium leprae/genética , Mycobacterium leprae/isolamento & purificação , Síndrome de Sweet/microbiologia , Síndrome de Sweet/patologiaRESUMO
Type 2 leprosy reactions commonly known as erythema nodosum leprosum, but various clinical manifestations of type 2 leprosy reaction were exist. The highlight of this case series was to report various atypical clinical manifestations of type 2 leprosy reaction such as reactive perforating leprosy, erythema multiforme-like reaction, and sweet's syndrome (SS)-like reaction.
Assuntos
Eritema Nodoso/patologia , Hanseníase Dimorfa/patologia , Hanseníase Virchowiana/patologia , Síndrome de Sweet/patologia , Adulto , Feminino , Humanos , Hansenostáticos/uso terapêutico , Hanseníase Dimorfa/tratamento farmacológico , Hanseníase Virchowiana/tratamento farmacológico , MasculinoRESUMO
History and clinical findings | A 42-year-old migrant from Brazil presented with persistent sensory disturbances, skin discolorations and local alopecia in the upper limbs. Decisive for the presentation in our Tropical Medicine Clinic were new occurrences of severe pain and redness and swelling in the area of the lesions that had already been assessed by a number of medical specialists without a clear diagnosis could be made. Investigations and diagnosis | The histological analysis of skin biopsies showed perivascular, perineural, periadnexial lymphocytic and granulomatous dermatitis. In a direct microbiological preparation individual acid fast bacilli could be detected (Ziehl-Neelsen stain). The electroneurographical examination demonstrated a sensitive peripheral-neurogenic damage with emphasis on the right median nerve and the left ulnar and radial nerves. Thermography revealed an increased heating or cooling threshold. The serological investigation by ELISA for IgM antibodies against the phenolic glycolipid (PGL-1) was positive (titer 1 : 1200). In summary, the diagnosis of borderline leprosy (infection with Mycobacterium leprae) with transition to multibacillary leprosy (according to WHO) and leprosy reaction type 1 was made. Treatment and course | We initiated an oral antimycobacterial therapy (multidrug therapy, MDT) with rifampin, clofazimine and dapsone for 12 months (WHO regimen for multibacillary leprosy). Leprosy reaction type 1 was treated with prednisolone and by increasing the dose of clofazimine. Analgesic therapy on demand was carried out with nonsteroidal anti-inflammatory drugs (ibuprofen). MDT and successful management of leprosy reaction lead to a rapid improvement of symptoms. Conclusions | Leprosy is an infectious disease occurring only rarely in Germany (average incidence of 1-2 cases per year) that is diagnosed almost exclusively among migrants. Main symptoms comprise non-itchy, reddish, touch insensitive skin lesions or nerve deficits. The diagnosis is based primarily on the clinical presentation, supplemented by pathogen detection, histology, neurophysiological findings and serology. Standard therapy is a combination of rifampin, clofazimine and dapsone (WHO scheme) for at least 6 months.
Assuntos
Emigrantes e Imigrantes , Hanseníase Dimorfa/diagnóstico , Doenças Negligenciadas , Adulto , Biópsia , Humanos , Hanseníase Dimorfa/patologia , Masculino , Exame Neurológico , Nervos Periféricos/patologia , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/patologia , Pele/patologiaAssuntos
Hanseníase Dimorfa/diagnóstico , Hanseníase Virchowiana/diagnóstico , Mycobacterium lepraemurium/isolamento & purificação , Pele/microbiologia , Adulto , Antibacterianos/uso terapêutico , Biópsia , Quimioterapia Combinada , Feminino , Glucocorticoides/uso terapêutico , Humanos , Hanseníase Dimorfa/tratamento farmacológico , Hanseníase Dimorfa/microbiologia , Hanseníase Dimorfa/patologia , Hanseníase Virchowiana/tratamento farmacológico , Hanseníase Virchowiana/microbiologia , Hanseníase Virchowiana/patologia , Mycobacterium lepraemurium/efeitos dos fármacos , Valor Preditivo dos Testes , Pele/efeitos dos fármacos , Pele/patologia , Resultado do TratamentoAssuntos
Hanseníase Dimorfa/patologia , Idoso , Histiócitos/patologia , Humanos , Macrófagos/patologia , MasculinoAssuntos
Fibroadenoma/complicações , Úlcera do Pé/etiologia , Hanseníase Dimorfa/complicações , Hanseníase Tuberculoide/complicações , Neoplasias das Glândulas Sudoríparas/complicações , Siringoma/complicações , Fibroadenoma/patologia , Úlcera do Pé/patologia , Humanos , Hanseníase Dimorfa/patologia , Hanseníase Tuberculoide/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias das Glândulas Sudoríparas/patologia , Siringoma/patologiaRESUMO
The histopathology of lepromatous skin varies according to the cell-mediated immunity of the host against Mycobacterium leprae. In tuberculoid and borderline tuberculoid leprosy, epithelioid noncaseating granulomas predominate, and acid-fast bacilli (AFB) are absent or only rarely present. In borderline lepromatous and lepromatous leprosy, the infiltrate is composed of macrophages with a vacuolar cytoplasm, lymphocytes, and plasma cells. AFB are numerous. Edema inside and outside the epithelioid granulomas, together with the appearance of large giant cells, are the main features of type 1 reactions. A conspicuous neutrophilic infiltrate in the subcutis with or without vasculitis is found in erythema nodosum leprosum. The main histopathologic features of leprosy and its particular forms are discussed in this review.
Assuntos
Eritema Nodoso/patologia , Hanseníase Dimorfa/patologia , Hanseníase Virchowiana/patologia , Hanseníase Tuberculoide/patologia , Pele/patologia , Biópsia por Agulha , Diagnóstico Diferencial , Progressão da Doença , Eritema Nodoso/fisiopatologia , Feminino , Humanos , Imuno-Histoquímica , Hanseníase Dimorfa/fisiopatologia , Hanseníase Virchowiana/fisiopatologia , Hanseníase Tuberculoide/fisiopatologia , Masculino , Recidiva , Medição de Risco , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Leprosy remains an important health problem mainly in the African and South-East Asia regions. Type 1 reaction is an immune-mediated phenomenon known to complicate at least 30% of patients of leprosy. Diagnosing type 1 reaction correctly is important for timely institution of therapy to prevent and treat neuropathy-associated disability and morbidity. There is paucity of literature on definitive criteria for histologic diagnosis of type 1 reaction. This study was conducted to determine the key histologic variables for diagnosing type 1 reaction. METHODS: This was a prospective study recruiting 104 patients with borderline leprosy. Three pathologists blinded to the clinical diagnosis independently assessed the cases. The agreement between each histological variable and clinical diagnosis was then calculated by using Cohen's kappa (Κ) coefficient. RESULTS: Histological diagnosis of type 1 reaction was given to 27 (67.5%) of 40 clinically diagnosed cases of type 1 reaction cases. Histological variables chosen as key variables for histological diagnosis of type 1 reaction were presence of giant cells, dermal edema, intragranuloma edema, granuloma fraction 31-50%, and presence of medium to large giant cells. CONCLUSION: This study has shown that T1R are still underdiagnosed histologically in comparison with clinical assessments. The key variables for diagnosing type 1 reaction were proposed.