Borderline tuberculoid leprosy in childhood onset systemic lupus erythematosus patient.

Leprosy is a contagious and chronic systemic granulomatous disease caused by the bacillus Mycobacterium leprae. To our knowledge, no case of leprosy in a childhood-onset systemic lupus erythematosus (c-SLE) patient has been reported. For a period of 31 years, 312 c-SLE patients were followed at the Pediatric Rheumatology Unit of our University Hospital. One of them (0.3%) had tuberculoid leprosy skin lesions during the disease course and is here reported. A 10-year-old boy from Northwest of Brazil was diagnosed with c-SLE based on malar rash, photosensitivity, oral ulcers, lymphopenia, proteinuria, positive antinuclear antibodies, anti-double-stranded DNA, anti-Sm and anti-Ro/SSA autoantibodies. He was treated with prednisone, hydroxychloroquine and intravenous cyclophosphamide, followed by mycophenolate mofetil. At 12-years-old, he presented asymmetric skin lesions characterized by erythematous plaques with elevated external borders and hypochromic center with sensory loss. Peripheral nerve involvement was not evidenced. No history of familial cases of leprosy was reported, although the region where the patient resides is considered to be endemic for leprosy. Skin biopsy revealed a well-defined tuberculoid form. A marked thickening of nerves was observed, often destroyed by granulomas, without evidence of Mycobacterium leprae bacilli. At that time, the SLEDAI-2K score was 4 and he had been receiving prednisone 15 mg/day, hydroxychloroquine 200 mg/day and mycophenolate mofetil 3 g/day. Paucibacillary treatment for leprosy with dapsone and rifampicine was also introduced. In conclusion, we have reported a rare case of leprosy in the course of c-SLE. Leprosy should always be considered in children and adolescents with lupus who present skin abnormalities, particularly with hypoesthesic or anesthesic cutaneous lesions.

Leprosy as a neglected disease and its stigma in the northeast of Brazil.

Hansen's disease is an infectious and degenerative chronic disease with a high potential for incapacitation. Due to the explosive epidemic of leprosy cases worldwide (especially in Brazil), the social difficulties faced by these patients are an important subject for research. This work aimed to identify the stigma experienced by these patients. The qualitative research for this study was completed at the National Reference Centre in Dermatology in Fortaleza. The study took place in northeast Brazil from September 2010 to November 2012. The research subjects included 20 people with Hansen's disease of both sexes between 20 and 70 years old. The data collection consisted of a semi-structured interview. From the discourse analysis of the participants, several changes experienced by persons affected by leprosy were noted from the empiric categories emerged. Changes occurred in the family, the receptiveness of neighbours and co-workers and the patients' social lives were experienced by the persons affected after the diagnosis of Hansen's disease. From the data obtained, it was concluded that the patients are stigmatised. Sometimes they are forced to hide from relatives, friends, neighbours and co-workers. Despite their social exclusion, they believe their isolation is justified. Leprosy is a chronic, degenerative and curable infectious illness that continues to be a serious public health problem, mainly in the poorest region of Brazil.