ABSTRACT
Panniculitides encompass a great number of different entities; however, once a vasculitis has been detected histopathologically within the subcutaneous tissue, the differential diagnosis is mainly restricted to polyarteritis (panarteritis) nodosa (PAN), nodular vasculitis (NV), and Bazin's erythema induratum (EI). Patients with PAN may have the disease confined to the skin, but must be followed over a long period because many of them develop late systemic disease. The NV/EI group represents by far the most common type of lobular panniculitis with vasculitis; we prefer keeping the distinction between the two entities by underlining the equation NV positive tuberculin skin test = EI. Other lobular panniculitides with vasculitis are exceedingly rare and set in a systemic background which can be infectious (lepromatous leprosy panniculitides) or autoimmune/dysreactive (neutrophilic lobular panniculitis in rheumatoid arthritis, lobular panniculitis in inflammatory bowel disease).
Subject(s)
Panniculitis/complications , Vasculitis/complications , Arthritis, Rheumatoid/complications , Disease Progression , Erythema Induratum/diagnosis , Erythema Induratum/pathology , Humans , Inflammatory Bowel Diseases/complications , Leprosy, Lepromatous/complications , Panniculitis, Nodular Nonsuppurative/diagnosis , Panniculitis, Nodular Nonsuppurative/pathology , Polyarteritis Nodosa/diagnosis , Polyarteritis Nodosa/pathology , Subcutaneous Fat/blood supply , Subcutaneous Fat/pathology , Thrombophlebitis/pathology , Vasculitis, Leukocytoclastic, Cutaneous/diagnosis , Vasculitis, Leukocytoclastic, Cutaneous/pathologyABSTRACT
In the clinical classification of leprosy the diffuse nonnodular form belongs to the lepromatous subtype. In these patients only a diffuse cutaneous infiltration without nodules or plaques is seen. Although the cutaneous features can be difficult to identify, the reactional state in these cases may lead to a serious necrotizing vasculitis, known as Lucio's phenomenon. We describe two cases of Lucio's phenomenon triggered by erysipelas. The diagnosis of leprosy was established only after the immunologic reaction had occurred. Both patients were treated with steroids and thalidomide. In the second case, the bacterial infection led to sepsis and death. In at-risk patients with a necrotizing vasculitis, leprosy should be considered in the differential diagnosis.
Subject(s)
Leprosy, Lepromatous/diagnosis , Polyarteritis Nodosa/diagnosis , Aged , Diagnosis, Differential , Erysipelas/diagnosis , Erysipelas/pathology , Female , Humans , Leprosy, Lepromatous/pathology , Microcirculation/pathology , Middle Aged , Polyarteritis Nodosa/pathology , Skin/blood supplyABSTRACT
The case histories of eight patients in the United Kingdom admitted to hospital for the diagnosis of leprosy are examined in detail. Review of their early symptoms and signs showed that there had been delays in diagnosis, ranging from a few months to many years. Possible reasons for delay are discussed, and attention is called to the importance of nasal symptoms in the early diagnosis of lepromatous leprosy.