Bullous erythema nodosum leprosum: a case report from Nepal.

A patient with lepromatous leprosy, while on WHO multidrug therapy (MDT) for multibacillary disease, was diagnosed as having dapsone syndrome with recurrent episodes of bullous lesions on the lower extremities for 4-5 years. The lesions were associated with high-grade fever. Examination revealed multiple hypopigmented macules on the limbs. Multiple atrophic scars were also found on the buttocks and lower limbs. Bilateral ulnar, radial cutaneous and lateral popliteal nerves were thickened. On day 10 of WHO-MB-MDT he developed a flaccid bulla on the lower leg. Skin slit smear showed a bacterial index (BI) of 3+ and the histopathology was consistent with type II reaction. High dose corticosteroid therapy was started but he continued to have new lesions, and was therefore referred to a centre where thalidomide was available. Clinical response was good and he remained symptom-free after gradual reduction in dosage. ENL should be differentiated from bullous drug reactions, pemphigus vulgaris, bullous pemphigoid and other blistering diseases.

Childhood leprosy in eastern Nepal: a hospital-based study.

A hospital-based retrospective study on childhood leprosy was carried out at B.R. Koirala Institute of Health Sciences, Dharan, covering the period April 1998-April 2002. 20 (4.45%) leprosy patients were detected in children aged 6-14 years. The male:female ratio was 4:1. History of contact was found in 10% of the patients. The commonest type of leprosy was borderline tuberculoid leprosy (550%), followed by borderline lepromatous leprosy (301%). Most of the patients had more than one lesion. Nerve involvement and grade 2 deformity were noted in 55% and 20% of the patients respectively. Slit skin smear was positive in 30% of patients.

Sexual habits and clinico-etiological profile of sexually transmitted diseases in Nepal.

A total of 100 patients giving histories suggestive of sexually transmitted disease (STDs) and attending the dermatology OPD at BPKIHS (B.P. Koirala Institute of Health Sciences) in Nepal over a period of one year from 1st July 1999 to 30th June 2000 were included in this study. Out of 10,400 new dermatology cases, a total of 100 cases (0.96%) of STDs were seen. Of these 73 were males, and the majority (53%) were in the age group of 21-30 years. Most of the patients were from Sunsari district (54%). The most common profession (21%) was businessman followed by housewife (19%). The most common age for first sexual contact was 16 to 19 years (45%). Eleven percent had their first sexual contact at the age of 15 or below 15 years. Premarital sexual exposure was recorded in 17% of the unmarried males. There were only 3 homosexuals and 1 bisexual patient. Multiple contacts were recorded in 55% of the patients. The most common source of contact was a commercial sex worker in 34.15%. Condoms were always used by only 7%. The various types of sexually trasmitted diseases (STDs) were syphilis (31%) followed by condylomata acuminata (16%), herpes genitalis (15%), gonorrhoea (9%), and mixed infections (12%). Despite their varied sexual behavior, none of the patients were HIV positive; however, it is always advisable to screen all STD patients for HIV antibody.

Post-kala-azar dermal leishmaniasis in Nepal.

BACKGROUND: Post-kala-azar dermal leishmaniasis (PKDL) manifests as a skin eruption after healing of visceral leishmaniasis (VL), either spontaneously or as a result of treatment. This study was undertaken to describe the demographic, clinical, and histopathologic features of PKDL in Nepal. METHODS: Demographic, clinical, microbiologic, and histopathologic features and response to treatment were studied in 22 patients with PKDL from April 1998 to March 2000. RESULTS: PKDL accounted for 0.13% of all new dermatologic cases. There were 13 (59.1%) males and nine (40.9%) females. A past history of kala-azar was present in all but one patient. A family history of kala-azar was noted in eight (36.4%) patients. All patients presented with multiple types of lesion, except for two in whom only macular lesions were seen. Oral lesions in the form of nodules and plaques were seen in four patients. Generalized lymphadenopathy was present in five patients. Slit skin smears revealed Leishman-Donovan bodies (LDBs) in nine (40.9%) patients. In macular lesions, there was a sparse infiltrate of plasma cells, lymphocytes, or histiocytes in the upper dermis. There was a dense chronic inflammatory infiltrate comprising plasma cells, lymphocytes, histiocytes, and epithelioid cells in the entire dermis from papules, plaques, or nodules. Giemsa staining of biopsy specimens revealed LDBs in seven (38.9%) patients only. Fine needle aspiration from epitrochlear lymph nodes in two patients demonstrated LDBs. All patients responded well to treatment with minimal side-effects. CONCLUSIONS: This study emphasizes the need to be aware of the possibility of cases of PKDL in endemic regions of leprosy, as the conditions may be difficult to distinguish clinically and histopathologically.

A clinico-mycological study of dermatophytoses in Nepal.

A clinico-mycological study of 100 cases of dermatophytosis was done in the B.P. Koirala Institute of Health Sciences in the eastern region of Nepal. The incidence of dermatophytoses in this study was 4.54% with a M: F ratio of 2.5: 1. The commonest age group was 11-20 years old. A single clinical type was found in 68%; 32% had two or more clinical types. The study revealed tinea corporis (43%) as the most common clinical type followed by tinea cruris (33%) and tinea pedis (20%). Positive culture was obtained in 94% of cases. A total of eight different species of dermatophytes were isolated with T. rubrum (45.74%) as the most common species followed by T. mentagrophytes (26.6%), T. tonsurans (11.7%), M. audouinii (8.36%), E. floccosum (4.26%), T. schoenlenii (2.13%), T. violaceum (2.13%) and T. verrucosum (1.06%).

Lichen planus after HBV vaccination in a child: a case report from Nepal.

Vaccination against hepatitis B virus has rarely been associated with lichen planus. We report a case of this kind in a child from Nepal. A 12-year-old boy had developed generalized itchy violaceous papules and plaques six weeks after the second dose of hepatitis B virus vaccine. Serum HBsAg and HBeAb were negative, but HBsAb was positive. New crops of generalized, similar eruptions developed after the booster dose of vaccine. All the lesions resolved within three months of systemic steroid therapy. There was no recurrence after one year of follow up. Awareness of such an association is necessary, especially in children, because vaccination campaigns are increasing.

Pyoderma gangrenosum associated with ulceratlve colitis-first case report from Nepal.

A case of pyoderma gangrenosum with ulcerative colitis from Nepal is reported. The patient responded well to a combination of oral steroids, clofazimine. dapsone and salazopyrine within a period of 3 months.

Port-wine-stain (nevus flammeus), congenital Becker's nevus, café-au-lait-macule and lentigines: phakomatosis pigmentovascularis type Ia--a new combination.

A 16-year-old male had brown macules in a geographic pattern with increased terminal hair on the back and dusky red partially blanchable non progressing macules on his left thigh since birth. Clinical diagnoses of Becker's nevus and port-wine-stain were made and confirmed histopathologically. In addition, he had multiple lentigines on the face and trunk and a single café-au-lait-macule on his chest.