RESUMEN
BACKGROUND: Erythema nodosum leprosum (ENL) is an immunologically mediated phenomenon complicating the course of leprosy. Reverse Koebner phenomenon is the term used to describe the sparing of previously injured or diseased skin by new skin lesions of the disease. METHODS: A middle-aged woman with a known case of lepromatous leprosy for the past year presented with an eruption of reddish painful nodules over her body. The lesions were found to characteristically spare the sites of previous scars. RESULTS: This sparing phenomenon of previous scar sites has been termed reverse Koebner phenomenon, a site of the body that offers greater resistance than the rest of the body to the onset of the disease, seen in various diseases, but it has never been described in ENL. CONCLUSION: This sparing of scar sites in ENL can be attributed to reverse Koebner phenomenon.
Asunto(s)
Eritema Nudoso , Hipersensibilidad , Lepra Lepromatosa , Lepra , Humanos , Persona de Mediana Edad , Femenino , Cicatriz/complicaciones , Cicatriz/patología , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/tratamiento farmacológico , Lepra Lepromatosa/patología , Piel/patología , Lepra/complicaciones , Hipersensibilidad/complicaciones , Hipersensibilidad/patologíaAsunto(s)
Dermatitis/genética , Desmogleína 1/genética , Mutación del Sistema de Lectura/genética , Hipersensibilidad/genética , Síndrome Debilitante/genética , Preescolar , Consanguinidad , Dermatitis/complicaciones , Dermatitis/patología , Homocigoto , Humanos , Hipersensibilidad/complicaciones , Hipersensibilidad/patología , India , Masculino , Síndrome Debilitante/complicaciones , Síndrome Debilitante/patologíaRESUMEN
An animal model of granulomatous hypersensitivity has been developed, which reproduces some features of the pathologies of important chronic granulomatous disorders, including tuberculosis, tuberculoid leprosy, sarcoidosis, berylliosis, Crohn's disease, and sensitivity to zirconium. The lesions consist of focal collections of epithelioid cells surrounded by lymphocytes to form tubercles. The epithelioid cell has a secretory function and is not phagocytic. Plasmacytoid dendritic cells are precursors of epithelioid cells, which are therefore part of the innate immune system. Subplasmalemmal linear densities are also present in these cells. This autoimmune model has been induced in rabbits using a non-myelin sensory peripheral antigen to reproduce the features of tuberculoid leprosy. The antigen is probably present only in human tissue. A granuloma antigen, which is tissue specific similar to that in peripheral nerves, could be present in sarcoidosis and Crohn's disease. In multiple sclerosis, mononuclear cells in the brain parenchyma are not phagocytic and are therefore similar to epithelioid cells. The induction of tolerance leading to the development of a vaccine to prevent the lesions in multiple sclerosis, sarcoidosis, and Crohn's disease is possible after purification of the granuloma antigen.