RESUMEN
Leprosy is a global health issue, causing long-term functional morbidity and stigma. Rapid diagnosis and appropriate treatment are important; however, early diagnosis is often challenging, especially in nonendemic areas. Here, we report a case of borderline lepromatous leprosy accompanied by dapsone-induced (neutropenia, anemia, and methemoglobinemia) and clofazimine-induced (skin discoloration and ichthyosis) side effects and type 1 leprosy reactions during administration of the multidrug therapy. The patient completely recovered without developing any deformities or visual impairment. To ensure early diagnosis and a favorable outcome, clinicians should be aware of the diminished sensation of skin lesions as a key physical finding and manage the drug toxicities and leprosy reactions appropriately in patients on multidrug therapy.
Asunto(s)
Hipersensibilidad , Lepra Dimorfa , Lepra Lepromatosa , Lepra Multibacilar , Lepra , Enfermedades del Sistema Nervioso Periférico , Enfermedades Cutáneas Bacterianas , Humanos , Clofazimina/efectos adversos , Dapsona/efectos adversos , Quimioterapia Combinada , Leprostáticos/efectos adversos , Lepra/patología , Lepra Dimorfa/diagnóstico , Lepra Dimorfa/tratamiento farmacológico , Enfermedades del Sistema Nervioso Periférico/tratamiento farmacológico , Lepra Multibacilar/tratamiento farmacológico , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/tratamiento farmacológico , Lepra Lepromatosa/patologíaRESUMEN
BACKGROUND: Leprosy in children is a strong indicator of the recent failure of leprosy control and disease transmission programs. For twenty-two years, leprosy has been declared `eliminated as a public health hazard,` yet new cases continue to emerge in endemic areas. The new case detection rate among the child population was recorded at 4.4 per million children. Because of their underdeveloped or neonatal immunity and exposure to intrafamilial contacts, children tend to be the most vulnerable population. CASE: We present a case of the borderline lepromatous type of leprosy in a 9-year-old Indonesian male patient with the chief complaint of three stiff fingers on his left hand that began four years ago and hypopigmented patches on the back and buttocks that began five years ago. In this case, there was a history of leprosy in his mother`s sister, who had died. Leprosy in the patient was suspected of possibly being transmitted from his mother`s sister who had intense contact with the patient. The results of bacteriological examination with Ziehl- Neelsen staining of tissue scrapings found acid-fast bacilli. He was treated with a multibacillary multidrug regimen for 12 months. Periodical observations after the patient received the treatment revealed no new spots on the patient`s skin, some of the previous hypopigmented patches seemed to fade, especially those on the back. CONCLUSIONS: In the absence of an effective vaccine, early diagnosis and treatment are critical in preventing disability and deformity and reducing the physical, psychosocial, and economic burden of the disease.
Asunto(s)
Lepra Dimorfa , Lepra Lepromatosa , Lepra Multibacilar , Lepra , Recién Nacido , Niño , Humanos , Masculino , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/tratamiento farmacológico , Lepra Dimorfa/diagnóstico , Lepra Dimorfa/tratamiento farmacológico , Lepra/diagnóstico , PielRESUMEN
ABSTRACT: Leprosy is a disease caused by Mycobacterium leprae that, depending on a patient's baseline susceptibility and immune system function, can present in a wide variety of ways. The host's immune system response to the infection can be cell-mediated or humoral and can be further altered by changes in immune function or treatment. Depending on the time at which a skin biopsy is taken from affected areas, different inflammatory cell types are present, and the histopathology can mimic that of other infectious, autoimmune, or malignant entities, especially when the clinical information provided is vague. We present a case of a 24-year-old Micronesian woman who initially presented immediately postpartum with clinical and histopathological findings suggestive of urticarial vasculitis, but a subsequent biopsy resulted in a diagnosis of erythema nodosum leprosum reaction and borderline multibacillary leprosy. This case illustrates an unusual clinical and histological presentation of M. leprae and highlights the importance of clinical history.
Asunto(s)
Lepra Dimorfa , Lepra , Urticaria , Vasculitis , Femenino , Humanos , Adulto Joven , Adulto , Mycobacterium leprae , Lepra Dimorfa/diagnóstico , Lepra Dimorfa/tratamiento farmacológicoAsunto(s)
Lepra Dimorfa , Síndrome de Melkersson-Rosenthal/patología , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Lepra/diagnóstico , Lepra/patología , Lepra Dimorfa/diagnóstico , Lepra Dimorfa/patología , Lepra Paucibacilar/diagnóstico , Lepra Paucibacilar/patología , Labio/patología , Mycobacterium leprae/aislamiento & purificaciónAsunto(s)
Antituberculosos/uso terapéutico , Leprostáticos/uso terapéutico , Lepra Dimorfa/diagnóstico , Lepra Multibacilar/diagnóstico , Mataderos , Antiinflamatorios/uso terapéutico , Clofazimina/uso terapéutico , Dapsona/uso terapéutico , Diagnóstico Diferencial , Humanos , Isoniazida/uso terapéutico , Tuberculosis Latente/complicaciones , Tuberculosis Latente/tratamiento farmacológico , Lepra Dimorfa/complicaciones , Lepra Dimorfa/tratamiento farmacológico , Lepra Dimorfa/patología , Lepra Multibacilar/complicaciones , Lepra Multibacilar/tratamiento farmacológico , Lepra Multibacilar/patología , Masculino , Persona de Mediana Edad , Prednisolona/uso terapéutico , Rifampin/uso terapéutico , Tromboflebitis/diagnósticoRESUMEN
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,.
Asunto(s)
Lepra Dimorfa/patología , Lepra Paucibacilar/patología , Lepra Dimorfa/diagnóstico , Lepra Paucibacilar/diagnósticoRESUMEN
INTRODUCTION: In metropolitan France, nearly 20 new cases of leprosy are diagnosed each year. The incidence of tuberculosis in France is 8/100,000 inhabitants and there are very few accounts of association of these two mycobacteria. Herein we report a case of co-infection with borderline tuberculoid (BT) leprosy and disseminated tuberculosis diagnosed in metropolitan France. PATIENTS AND METHODS: A male subject presented with diffuse painless infiltrated erythematous plaques. The biopsy revealed perisudoral and perineural lymphohistiocytic epithelioid cell granuloma as well as acid-alcohol-fast bacilli on Ziehl staining. PCR was positive for Mycobacterium leprae, confirming the diagnosis of leprosy in the BT form. The staging examination revealed predominantly lymphocytic left pleural effusion, right-central necrotic adenopathy without histological granuloma, negative screening for BK, a positive QuantiFERON-TB™ test, and a positive intradermal tuberculin reaction. The clinical and radiological results militated in favour of disseminated tuberculosis. Combined therapy (rifampicin, isoniazid, ethambutol and pyrazinamide) together with clofazimine resulted in regression of both cutaneous and extra-cutaneous lesions. This rare co-infection combines leprosy, often present for several years, and tuberculosis (usually pulmonary) of subsequent onset. The pathophysiological hypothesis is that of cross-immunity (with anti-TB immunity protecting against subsequent leprosy and vice versa), supported by the inverse correlation of the two levels of prevalence and by the protection afforded by tuberculosis vaccination. In most cases, treatment for TB and leprosy improves both diseases. Patients presenting leprosy should be screened for latent tuberculosis in order to avoid reactivation, particularly in cases where corticosteroid treatment is being given.
Asunto(s)
Lepra Dimorfa , Lepra Tuberculoide , Lepra , Tuberculosis , Humanos , Lepra Dimorfa/diagnóstico , Lepra Dimorfa/tratamiento farmacológico , Lepra Tuberculoide/diagnóstico , Lepra Tuberculoide/tratamiento farmacológico , Masculino , Mycobacterium leprae , PielAsunto(s)
Glucocorticoides/efectos adversos , Lepra Dimorfa/diagnóstico , Lepra Lepromatosa/diagnóstico , Mycobacterium leprae/aislamiento & purificación , Piel/efectos de los fármacos , Administración Cutánea , Adulto , Infecciones Asintomáticas , Biopsia , Diagnóstico Diferencial , Errores Diagnósticos , Quimioterapia Combinada/métodos , Eccema/diagnóstico , Eccema/tratamiento farmacológico , Glucocorticoides/administración & dosificación , Humanos , Leprostáticos/uso terapéutico , Lepra Dimorfa/tratamiento farmacológico , Lepra Dimorfa/inmunología , Lepra Dimorfa/microbiología , Lepra Lepromatosa/tratamiento farmacológico , Lepra Lepromatosa/inmunología , Lepra Lepromatosa/microbiología , Masculino , Piel/inmunología , Piel/microbiología , Piel/patología , Tiña/diagnóstico , Tiña/tratamiento farmacológicoAsunto(s)
Lepra Dimorfa/diagnóstico , Lepra Lepromatosa/diagnóstico , Tiña Versicolor/diagnóstico , Biopsia , Niño , Diagnóstico Diferencial , Femenino , Humanos , Leprostáticos/uso terapéutico , Lepra Dimorfa/tratamiento farmacológico , Lepra Dimorfa/patología , Lepra Lepromatosa/tratamiento farmacológico , Lepra Lepromatosa/patología , Piel/patologíaRESUMEN
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.
Asunto(s)
Dermatitis Exfoliativa/complicaciones , Lepra Dimorfa/etiología , Lepra Lepromatosa/etiología , Anciano , Biopsia , Dermatitis Exfoliativa/diagnóstico , Dermatitis Exfoliativa/patología , Diagnóstico Diferencial , Humanos , Lepra Dimorfa/diagnóstico , Lepra Dimorfa/patología , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/patología , MasculinoRESUMEN
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.
Asunto(s)
Humanos , Masculino , Anciano , Lepra Dimorfa/etiología , Lepra Lepromatosa/etiología , Dermatitis Exfoliativa/complicaciones , Biopsia , Lepra Dimorfa/diagnóstico , Lepra Dimorfa/patología , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/patología , Dermatitis Exfoliativa/diagnóstico , Dermatitis Exfoliativa/patología , Diagnóstico DiferencialRESUMEN
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.
Asunto(s)
Antibacterianos/uso terapéutico , Lepra Dimorfa/diagnóstico , Mycobacterium leprae/aislamiento & purificación , Biopsia , Quimioterapia Combinada/métodos , Humanos , Lepra Dimorfa/tratamiento farmacológico , Lepra Dimorfa/patología , Masculino , Persona de Mediana Edad , Piel/microbiología , Piel/patología , Resultado del TratamientoAsunto(s)
Edema/microbiología , Lepra Dimorfa/diagnóstico , Lepra Dimorfa/tratamiento farmacológico , Lepra Multibacilar/diagnóstico , Lepra Multibacilar/tratamiento farmacológico , Anciano , Antiinflamatorios/uso terapéutico , Quimioterapia Combinada , Eritema/microbiología , Femenino , Humanos , Leprostáticos/uso terapéutico , Lepra Dimorfa/complicaciones , Lepra Multibacilar/complicaciones , Neuralgia/microbiología , Parestesia/microbiología , Prednisolona/uso terapéutico , Prurito/microbiologíaAsunto(s)
Erupciones por Medicamentos/diagnóstico , Lepra Dimorfa/complicaciones , Lepra Dimorfa/diagnóstico , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/diagnóstico , Trombosis de la Vena/microbiología , Anciano , Antivirales/uso terapéutico , Diagnóstico Diferencial , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/tratamiento farmacológico , Humanos , Masculino , Enfermedades del Sistema Nervioso Periférico/microbiología , Recurrencia , Sofosbuvir/uso terapéuticoRESUMEN
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.