IL-37 and leprosy: A novel cytokine involved in the host response to Mycobacterium leprae infection.

Leprosy is a chronic infectious granulomatous disease caused by Mycobacterium leprae, in which the clinical outcome depends on the pattern of the host immune response. Because it is a spectral disease, leprosy is a good model for studying the immunology of the pathogen-host relationship. Although previous studies have characterized the participation of cytokine profiles such as Th1, Th2, Th7, Treg, Th9, and Th22 responses in leprosy, the role of new cytokines such as IL-37 have not yet been described for the spectral model of the disease. Here, we used an immunohistochemical technique to evaluate IL-37 expression in the skin of patients with leprosy. The expression of this cytokine was observed in the keratinocytes, endothelial cells, macrophages, and lymphocytes. Moreover, the IL-37 expression level was increased in patients with the tuberculoid (TT) form when compared to those with the lepromatous leprosy (LL) form in keratinocytes, endotheliocytes, and lymphocytes. However, in the macrophages, the cytokine expression was more intense in the LL form of the disease. These results point to the effective participation of IL-37 in the immunopathogenesis of leprosy, which is expressed in both the epidermal cells and the dermis.

Cutaneous plasmacytosis: A rare entity with unique presentation.

Primary cutaneous plasmacytosis is a rare cutaneous disorder with extensive cutaneous plaques/papules mainly on the trunk and face. Cases have mostly been documented from Japan. We present here a rare case of cutaneous plasmacytosis from India of Mongolian descent. This 50-year-old female from Mizoram had extensive maculo-papular violaceous plaques distributed on the face, axillae, trunk and lower extremities. Initial and repeat skin biopsy revealed dense perivascular and periadnexal mature plasma cells. She also had lymphadenopathy. Serum protein electrophoresis did not reveal any M band and the Bence Jones protein was negative in urine. The patient had multiple superficial lymph nodes and a biopsy from the cervical lymph node showed effacement of normal nodal architecture by sheets of plasma cells. Immuno histochemistry was done from both skin and lymph node biopsies. The kappa and lambda tight chains were not restricted; there by proving the polyclonal nature of the plasma cells. The novelty of the case lies in its classical clinical presentation with histopathological documentation.

Leprosy in a patient infected with HIV.

A 60-year-old Nigerian man, who had lived in Europe for 30 years but had returned home frequently, presented with right frontalis muscle weakness and right ulnar nerve palsy, without skin lesions. Neurophysiology showed a generalised neuropathy with demyelinating features. Blood tests were positive for HIV, with a normal CD4 count. There was nerve thickening both clinically and on MRI. Nerve biopsy showed chronic endoneuritis and perineuritis (indicating leprosy) without visible mycobacteria. His neuropathy continued to deteriorate (lepra reaction) before starting treatment with WHO multidrug therapy, highly active antiretroviral therapy and corticosteroids. There are 10 new cases of leprosy diagnosed annually in the UK. Coinfection with HIV is rare but paradoxically does not usually adversely affect the outcome of leprosy or change treatment. However, permanent nerve damage in leprosy is common despite optimal therapy. Leprosy should be considered in patients from endemic areas who present with mononeuritis multiplex.

Phytochemical investigation and radical scavenging activities of Melia azedarach and its DNA protective effect in cultured lymphocytes.

CONTEXT: Melia azedarach Linn (Meliaceae) is an Ayurvedic medicinal plant which is native to India. It is traditionally used for the treatment of leprosy, inflammation, scrofula, anthelmintic, antilithic, diuretic, deobstruent and cardiac disorders. OBJECTIVE: To evaluate the phytochemical constituents and antioxidant activities of the ethanol leaf extract of Melia azedarach (MA) and its protective effect against H2O2-induced cellular damage in cultured lymphocytes. MATERIALS AND METHODS: The dose-dependent study of MA (20, 40, 60, 80, 100 µg/ml) was used to study in vitro radical scavenging assays. The effective dose of MA (60 µg/ml) was further used to study the H2O2-induced DNA damage (comet assay and DNA fragmentation assay) in cultured lymphocytes. RESULTS: The ethanol extract of MA (20, 40, 60, 80, 100 µg/ml) exhibited a significant dose-dependent inhibition of in vitro radical scavenging assays and their corresponding IC50 values as follows: hydroxyl radical (26.50 ± 0.26 µg/ml), superoxide anion (30.00 ± 0.32 µg/ml), nitric oxide radical (48.00 ± 0.48 µg/ml), DPPH radical (30.55 ± 0.32 µg/ml) and reducing power (22.00 ± 0.22 µg/ml). The increase in the severity of DNA damage and TBARS was increased significantly (p<0.05) at 500 µM H2O2-treated cultured lymphocytes and RBC cellular membranes. The phytochemical screening studies identified 13 chemical constituents present in the leaf extract of MA. DISCUSSION AND CONCLUSION: The results of this study demonstrate that MA offers protection against H2O2-induced cellular damage and it can be developed as an effective antioxidant during oxidative stress.

Acquired Blaschkoid dermatitis.

Acquired Blaschkoid dermatitis characterised by unilateral relapsing inflammatory disease along the lines of Blaschko. A 40-year-old Indian male presented with unilateral erythematous, itchy grouped papules on the left side of the chest, abdomen, back and left arm of 15 days duration. The eruption stopped abruptly at the midline of the torso, completely sparing the right side of the body. The lesions were arranged in whorls and streaks corresponding to the lines of Blaschko. Skin biopsy showed hyperkeratosis and features suggestive of sub-acute spongiotic dermatitis with lymphocytic infiltrate around the blood vessels in the dermis. Patient was diagnosed as a case of Blaschkoid dermatitis. To the best of our knowledge, this is the first case of this condition being reported from India.

Single lesion borderline lepromatous leprosy.

A patient is reported who presented with a single lesion on the face which, on histopathological examination, was found to be borderline lepromatous leprosy. The importance of doing skin smears as a routine in all patients to differentiate Multibacillary from Paucibacillary disease is emphasized.

Histological changes in the nerve, skin and nasal mucosa of patients with primary neuritic leprosy.

Primary neuritic leprosy (PNL) presents as a peripheral neuropathy with no visible skin patches and skin smears negative for acid fast bacilli. The pathogenesis of PNL is poorly understood. The aim of the study was to document the histological changes in the nerve, apparently normal skin and nasal mucosa in PNL and to study its significance to the pathogenesis of leprosy lesions. The study is based on a cohort of 208 PNL patients registered at the Schieffelin Leprosy Research and Training Centre, Karigiri. All patients had a nerve biopsy, 196 had a skin biopsy and 39 had a nasal mucosal biopsy. The findings reveal that PNL patients exhibit a spectrum of disease histologically in the nerve ranging from lepromatous to tuberculoid leprosy with a significant proportion (46%) manifesting a multibacillary leprosy histology. Findings in the apparently normal skin and nasal mucosa reveal that there are widespread changes due to leprosy in tissues such as the skin and nasal mucosa even when the disease appears clinically confined to a few nerves. PNL may be an early stage in the pathogenesis of the disease before the appearance of skin lesions. The number of nerves enlarged and lepromin status did not give any clue to the nature of underlying disease.

Cytomorphology of leprosy across the Ridley-Jopling spectrum.

OBJECTIVE: To evaluate the possible role of cytology in classifying leprosy lesions on the Ridley-Jopling scale. STUDY DESIGN: A double-blind, prospective study comparing cytologic assessment of 30 clinically diagnosed cases of leprosy with their histopathology. May-Grünwald-Giemsa and Ziehl-Neelsen stain were done on slit skin smears and fine needle aspiration material. RESULTS: Cytologic subclassification was possible in 23 cases as tuberculoid leprosy (11), midborderline (3), borderline lepromatous (5) and lepromatous leprosy (4). These correlated with histologic subtypes. CONCLUSION: May-Grünwald-Giemsa complements Ziehl-Neelsen stain, yielding information almost comparable to that from histologic examination of skin biopsies.

Nodular lepromatous leprosy: report of a case diagnosed by FNA.

Lepromatous leprosy can present with skin nodules which can be misdiagnosed as soft tissue tumors or infected cysts. FNA can be diagnostic if unstained, refractile, intracellular mycobacteria are recognized on Romanowsky stained smears. Fite stain for Mycobacterium leprae confirms the diagnosis. Awareness of the differential diagnosis of skin nodules yielding foamy histiocytes on FNA, briefly discussed, should help avoid error.