Enfermedad de Hansen en un adulto con virus de inmunodeficiencia humana / Hansen's disease in an adult infected with human immunodeficiency virus i: en

Se describe el caso clínico de un paciente infectado por el virus de la inmunodeficiencia humana en fase sintomática precoz, quien fue asistido en el Servicio de Dermatología del Hospital Clínico Quirúrgico Docente Dr. León Cuervo Rubio en Pinar del Río por presentar lesiones eritematosas infiltradas de tres meses de evolución en el miembro inferior derecho, con alteración de la sensibilidad térmica y dolorosa. Se le indicó baciloscopia y estudio histopatológico que confirmaron el diagnóstico de sospecha de lepra dimorfa tuberculoide, por lo que se comenzó a aplicar poliquimioterapia combinada con terapia antirretroviral, lo cual favoreció la evolución del paciente.

The case report of a patient infected by the human immunodeficiency virus in early symptomatic phase is described, who was seen at the Dermatology Service of the Dr. León Cuervo Rubio Teaching Clinical Surgical Hospital of Pinar del Río for presenting infiltrated erythematous lesions of three months of evolution in the right lower limb, with altered pain and thermal sensation. A basiloscopic and histopathologic study was indicated, which confirmed the presumptive diagnosis of borderline tuberculoid leprosy, and therefore polychemotherapy combined with antiretroviral therapy was started, which favored the patient's evolution.

Oral Involvement in Borderline Tuberculoid Leprosy: Report of a Case with Review of Literature.

Leprosy is a chronic infectious granulomatous disease caused by Mycobacterium leprae, primarily affecting the skin and the peripheral nerves. Variable involvement of internal organs and mucosa has been reported with incidence ranging from 19% to 60%, more commonly seen in lepromatous spectrum of leprosy (LL and BL). We report a case of borderline tuberculoid (BT) leprosy presenting with oral mucosal lesions involving the gingival mucosa and lower lip.

Reacción lepromatosa tipo I, a propósito de un caso / Type I lepra reaction: a case report

La lepra es una infección crónica, granulomatosa, producida por Mycobacterium leprae, que afecta piel y nervios periféricos. Se describen dos tipos de reacciones leprosas: tipo I y tipo II, las que corresponden a cuadros agudos que exacerban la enfermedad. Estas leproreacciones pueden ocurrir antes, durante o después del tratamiento. Se presenta el caso de un paciente masculino que acude a consultar con lesiones cutáneas y resultado de biopsia de piel con diagnóstico de lepra. Se inicia tratamiento multidroga OMS-MB1. Posteriormente presenta una leproreacción tipo I, por lo que se le realiza tratamiento con prednisona.

Leprosy is a chronic granulomatous infection of the skin and peripheral nervous system produced by Mycobacterium leprae. Two types of acute leprosy reactions have been described: type I and type II. These reactions can occur before, during or after treatment. We present the case of an adult male patient presenting with skin lesions and skin biopsy diagnostic for leprosy. A multidrug WHO-MB 1 treatment was initiated, after which he presents with type I lepra reaction requiring corticosteroids.

Enfermedad de hansen (lepra): Eritema nodoso leproso presentación de caso / Hansen disease (leprosy): Erythema nodosum leprosum case presentation

La enfermedad de Hansen o lepra es una enfermedad infectocontagiosa de curso crónico tan antigua como la humanidad misma, que a lo largo de la historia ha marginado a todo aquel que la padece. En la actualidad con el conocimiento de su patogenia y avances en la terapéutica se tiene una visión diferente de la misma. En los siguientes párrafos se realiza una revisión bibliográfica actualizada y la presentación del caso clínico de un paciente de 44 años de edad, al cual se le diagnostico lepra lepromatosa con desarrollo de eritema nodoso leproso quien recibió manejo poliquimioterapéutico con adecuada evolución.

Hansen's disease or leprosy is a chronic course infectious disease as old as humanity itself, which throughout history has led to the isolation and alienation of anyone who has it. Nowadays due to pathogenesis knowledge and therapeutics advance we can have a different point of view about it. In the following sections we will perform an updated revision of this disease and check a 44 year-old patient case, who was diagnosed with lepromatous leprosy developing a nodosum leprosum erythema and who has also received the appropriate multidrug treatment with appropriate clinical response.

A Case of Leprosy in Italy: A Multifaceted Disease Which Continues to Challenge Medical Doctors.

Leprosy is a chronic infectious disease caused by Mycobacterium leprae, characterized by a very long incubation period, confounding signs and symptoms and difficulty to establish the onset time. Considering the stigma associated with the diagnosis and the difficulties in detecting asymptomatic leprosy, the incidence and prevalence of this disease are underestimated. In Italy, leprosy is currently included among the rare diseases and can occur as an imported pathology in native individuals or extra-EU immigrants. Currently, given its exceptional appearance in Italy, leprosy is extremely difficult to recognize. In fact, the incomplete knowledge by the medical class of geographical epidemiology and aetiology of tropical diseases including leprosy, often delays the definitive diagnosis. Due to the increasing rate of the migration flows, in Italy and in Europe, leprosy should be considered among the differential diagnosis in patients with cutaneous and neurological signs, especially when originating from endemic countries.

Surgical treatment of type I neuritis in a teenage boy with borderline tuberculoid leprosy

Exacerbation of the immune response against Mycobacterium leprae can lead to neuritis, which is commonly treated via immunosuppression with corticosteroids. Early neurolysis may be performed concurrently, especially in young patients with a risk of functional sequelae. We report the case of a young patient experienced intense pain in the left elbow one year after the treatment of tuberculoid-tuberculoid leprosy. The pain was associated with paresthesias in the ulnar edge and left ulnar claw. After evaluation, the diagnosis was changed to borderline tuberculoid leprosy accompanied with neuritis of the left ulnar nerve. Early neurolysis resulted in rapid reduction of the pain and recovery of motor function.

Evaluation of apoptosis in skin biopsies of patients of borderline leprosy and lepra type 1 reaction.

BACKGROUND: The role of apoptosis is not clear in leprosy and lepra reactions. OBJECTIVES: To evaluate frequency of apoptosis in skin lesions of borderline leprosy and Type 1 lepra reaction. METHODS: Sixty patients with borderline leprosy (30 with clinically diagnosed Type 1 reaction (T1R) (Group I) and 30 without clinical evidence of reaction (Group II)) were analyzed in this prospective study. Apoptosis was detected by two different methods for comparison, that is, histopathologic examination (HPE) and deoxyribonucleic acid (DNA) fragmentation and electrophoresis. Quantification of apoptotic bodies/10 high power fields (HPF) was also done. RESULTS: Out of 30 cases, apoptosis was detected in 29 cases in Group I and 24 cases in Group II by HPE (P = 0.103), whereas, with the use of DNA electrophoresis it was detected in 24 cases in Group I and 18 cases in Group II (P = 0.091). On quantitative estimation it was found that number of apoptotic bodies are higher in Group I in comparison to Group II (2.77 vs 1.99), which is statistically significant. CONCLUSIONS: There was moderate agreement (κ = 0.47) between the two methods of apoptosis detection. Apoptosis was seen more in patients with T1R both qualitatively (statistically nonsignificant) and quantitatively (statistically significant). Clinical significance of this novel finding is that apoptosis can be used as one of the variables for diagnosis of T1R to increase detection rate.

Clofazimine-induced Hair Pigmentation.

A 45-year-old man was treated with WHO multibacillary multidrug therapy for borderline leprosy and high dose daily Clofazimine for lepra reaction. Along with the expected side effect of skin pigmentation, the patient also noticed darkening of previously grey hair. This colour persisted eight months after completing multibacillary multidrug therapy.

Early diagnosis of relapse in borderline leprosy: two case reports / Diagnóstico precoce de recidiva em hanseníase dimorfa: apresentação de dois casos

Two cases of relapse in borderline leprosy were reported. Despite the late-reversal, reaction-like feature, the suspicion of relapse in both was based on persistent and slow-developing skin lesions and an absence of acute neuritis or reaction during one year of follow-up. The authors have considered this possible occurrence in lepromatous borderline-treated patients after their immune cellular restoration and defend that not all Type 1 reactions would be an inflammatory answer to persistent Mycobacterium leprae, but that they could be. Therefore, a relapse diagnosis could be applied and it is more advisable, as one year of Multi-Drug Therapy (MDT) is less dangerous and more efficient for these cases than one year of corticosteroids.

São apresentados dois casos de recidiva de hanseníase borderline. Apesar das características de reação reversa tardia, a suspeita de recidiva foi baseada no desenvolvimento insidioso e persistente de lesões cutâneas sem reação e neurite agudas, durante um ano de seguimento. Os autores consideram a possibilidade de recidiva em pacientes borderline virchowinano tratados, pela restauração da imunidade celular e postulam que embora nem toda reação tipo 1 seja devida a presença de M. leprae persistentes, isso também pode ocorrer. Assim, o diagnóstico de recidiva foi considerado ressaltando-se que um ano de poliquimioterapia oferece menos danos e pode ser mais eficiente nesses casos, que um ano de corticosteróides.

Sorologia rápida para hanseníase (teste ML Flow) em pacientes dimorfos classificados como paucibacilares pelo número de lesões cutâneas: uma ferramenta útil / Leprosy serology (ml Flow test) in borderline leprosy patients classified as paucibacillary by counting cutaneous lesions: an useful tool

A hanseníase ainda é doença endêmica no Brasil, com cerca de 40.000 novos casos por ano. Devido à dificuldade na realização de exames laboratoriais em campo, classifica-se a forma clínica contando-se lesões, o que pode causar subdiagnóstico de casos multibacilares e falha terapêutica. Para avaliar uma nova ferramenta para diagnóstico de hanseníase multibacilar, o teste ML Flow, foi realizado em 21/77 (27,3%) pacientes com hanseníase dimorfa (6 DV e 15 DT) não tratados, com até cinco lesões de pele, avaliados de acordo com a classificação de Ridley & Jopling (R&J). O teste ML Flow foi positivo em 14/21 (66,6%) pacientes (4 DV e 10 DT); em 7/21 (33,3%) pacientes (5 DT e 2 DV) o resultado foi negativo. A classificação da hanseníase baseada somente na contagem de lesões pode falhar em diagnosticar casos MB. O ML Flow é ferramenta útil no diagnóstico de hanseníase dimorfa com até cinco lesões cutâneas.

Leprosy remains an endemic disease in Brazil, with almost 40,000 new cases diagnosed each year. As it is difficult to perform laboratory procedures in the field, operational classification is determined by counting lesions, which can cause underdiagnosis of multibacillary cases and failures in treatment. To evaluate a new tool to diagnose MB cases, the ML Flow test, 21/77 (27.3%) patients with untreated borderline leprosy (6 BL and 15 BT) with 1 to 5 cutaneous lesions were evaluated according to the R&J Classification. The ML Flow test was positive in 14/21 (66.6%) patients; 7/21 (33.3%) cases, 5 BT and 2 BL, showed negative results. Classification of leprosy based only on the number of lesions can fail to diagnose MB leprosy. The ML Flow test is a useful tool to diagnose borderline leprosy in patients with 1 to 5 cutaneous lesions.

Reação reversa nodular tardia simulando recidiva: a importância da história clínica e dos exames laboratoriais / Late nodular reversal reaction mimicking relapse: the importance of clinical history and laboratory findings

Um homem de 51 anos recebe o diagnóstico de hanseníase dimorfa em 2005. Na ocasião apresentou 3 lesões em placas foveolares e algumas pequenas pápulas no tronco posterior. A histopatologia mostrou quadro ativo de Hanseníase dimorfa-virchoviana com baciloscopia de 5+ (presença de bacilos típicos). A reação de Mitsuda foi negativa, a dosagem de IgM anti-PGL-1 (glicolipídeo fenólico 1) por ELISA foi de 0,003 e o teste ML-Flow (teste de fluxo lateral para o M. leprae) foi negativo. Submeteu-se a poliquimioterapia (PQT) para multibacilar (24 doses). Nove meses após a alta medicamentosa, inicia episódio reacional caracterizado por tumefação e eritema das placas pré-existentes, e múltiplos nódulos eritematosos generalizados em face, tronco e extremidades. A histopatologia demonstrou padrão granulomatoso dimorfo-tuberculóide reacional com 1+ de bacilos granulosos. Discute-se o diagnóstico diferencial entre recidiva e reação reversa, a reativação com múltiplos nódulos semelhantes a hansenomas e os valores de IgM anti PGL-1 e o teste de ML-Flow negativo por ocasião do diagnóstico da doença.

A 51 years old man has the diagnosis of borderline leprosy in 2005. On this time he presented 3 honeycombed plaques and some little papules on the back. The histopathology showed active borderline-lepromatous leprosy, bacilloscopy 5+, with viable bacilli. Mitsuda reaction was negative, the dosage of IgM anti-PGL-1 (phenolic glicolipid 1) by ELISA was 0,003 and ML-Flow test (lateral flux test to M. leprae) was negative. Multidrugtherapy (MDT) for multibacillary leprosy was started for 24 months. Nine months after finished treatment, reversal reaction characterized by exacerbation of previous lesions and appearance of multiple erythematous nodules on face, trunk and extremities. The histopathology showed reactional borderline-tuberculoid pattern, with bacilloscopy 1+, granular bacilli. It is discussed the differential diagnosis between relapse and reversal reaction, the reactivation of the disease with multiple nodules mimicking lepromas and the low values of IgM anti-PGL-1 and the negative ML-flow test on the diagnosis.