Lobomycosis: exuberant presentation with malignant transformation

Abstract Lobomycosis is a chronic granulomatous infection caused by the yeast Lacazia loboi, typically found in tropical and subtropical geographical areas. Transmission occurs through traumatic inoculation into the skin, especially in exposed areas, of men who work in contact with the soil. Lesions are restricted to the skin and subcutaneous tissue, with a keloid-like appearance in most cases. The occurrence of squamous cell carcinoma on skin lesions with a long evolution is well known; however, there are scarce reports of lobomycosis that developed into squamous cell carcinoma. The authors report a patient from the Brazilian Amazon region, with lobomycosis and carcinomatous degeneration, with an unfavorable outcome, due to late diagnosis.

Lobomycosis: exuberant presentation with malignant transformation.

Lobomycosis is a chronic granulomatous infection caused by the yeast Lacazia loboi, typically found in tropical and subtropical geographical areas. Transmission occurs through traumatic inoculation into the skin, especially in exposed areas, of men who work in contact with the soil. Lesions are restricted to the skin and subcutaneous tissue, with a keloid-like appearance in most cases. The occurrence of squamous cell carcinoma on skin lesions with a long evolution is well known; however, there are scarce reports of lobomycosis that developed into squamous cell carcinoma. The authors report a patient from the Brazilian Amazon region, with lobomycosis and carcinomatous degeneration, with an unfavorable outcome, due to late diagnosis.

Ulcers in leprosy patients, an unrecognized clinical manifestation: a report of 8 cases.

BACKGROUND: Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae. It is a polymorphic disease with a wide range of cutaneous and neural manifestations. Ulcer is not a common feature in leprosy patients, except during reactional states, Lucio's phenomenon (LP), or secondary to neuropathies. CASES PRESENTATION: We report eight patients with multibacillary leprosy who presented specific skin ulcers as part of their main leprosy manifestation. Ulcers were mostly present on lower limbs (eight patients), followed by the upper limbs (three patients), and the abdomen (one patient). Mean time from onset of skin ulcers to diagnosis of leprosy was 17.4 months: all patients were either misdiagnosed or had delayed diagnosis, with seven of them presenting grade 2 disability by the time of the diagnosis. Reactional states, LP or neuropathy as potential causes of ulcers were ruled out. Biopsy of the ulcer was available in seven patients: histopathology showed mild to moderate lympho-histiocytic infiltrate with vacuolized histiocytes and intact isolated and grouped acid-fast bacilli. Eosinophils, vasculitis, vasculopathy or signs of chronic venous insufficiency were not observed. Skin lesions improved rapidly after multidrug therapy, without any concomitant specific treatment for ulcers. CONCLUSIONS: This series of cases highlights the importance of recognizing ulcers as a specific cutaneous manifestation of leprosy, allowing diagnosis and treatment of the disease, and therefore avoiding development of disabilities and persistence of the transmission chain of M. leprae.

Evidências científicas sobre as úlceras de pernas como sequela da hanseníase / Evidencias científicas sobre las úlceras de piernas como secuela de la lepra / Scientific evidence on leg ulcers as leprosy sequel

Resumo Objetivo Investigar as evidências científicas sobre as úlceras de pernas como sequela da hanseníase. Métodos Revisão Integrativa da Literatura (RIL). Para identificação do tema e questão de pesquisa, utilizou-se a estratégia PICo, na sequencia procedeu-se a busca nas bases de dados: Index to Nursing and Allied Health Literature (Cinahl), Literatura Latino-americana e do Caribe em Ciências da Saúde (Lilacs), Banco de dados em Enfermagem (BDENF), EMBASE (Elsevier), PUBMED (National Library of Medicine), SCOPUS (Elsevier), Web of Science (Clarivate Analytics), selecionados os descritores específicos para cada uma delas e elaboradas as respectivas estratégias de busca. Os idiomas considerados foram: inglês, português e espanhol. O período da RIL foi indeterminado. Para a seleção dos estudos, utilizou-se a ferramenta Ryyan que permitiu dois dos autores independentemente incluir, excluir, ou ficar indeciso, as discordâncias foram solucionadas por um terceiro. Os artigos selecionados foram classificados de acordo com a Agency for Healthcare Research and Quality (AHRQ). E para a interpretação dos resultados os artigos foram agrupados por semelhança e categorizados da seguinte maneira: autor, ano país, nível de evidência, objetivos e resultados, conclusão e recomendação. Resultados Identificou-se 415 estudos e 10 foram incluídos na revisão. O resultado principal obtido foi o tratamento tópico da úlcera, as vulnerabilidades e os determinantes que assolam os acometidos pela hanseníase não foram estudados. Conclusão Não há fortes evidências sobre as terapias para o tratamento de úlceras de pernas decorrentes da hanseníase que apoiem a diminuição de sequelas incapacitantes ocasionadas pela doença perpetuando o estigma e a desigualdade social.

Resumen Objetivo investigar las evidencias científicas sobre las úlceras de piernas como secuela de la lepra. Métodos revisión integradora de la literatura (RIL). Para la identificación del tema y pregunta de la investigación, se utilizó la estrategia PICo, luego se procedió a la búsqueda en las bases de datos: Index to Nursing and Allied Health Literature (Cinahl), Literatura Latinoamericana y del Caribe en Ciencias de la Salud (Lilacs), Banco de dados em Enfermagem (BDENF), EMBASE (Elsevier), PUBMED (National Library of Medicine), SCOPUS (Elsevier), Web of Science (Clarivate Analytics), se seleccionaron los descriptores específicos para cada una y se elaboraron las respectivas estrategias de búsqueda. Se consideraron los idiomas inglés, portugués y español. El período de la RIL fue indeterminado. Para la selección de los estudios, se utilizó la herramienta Ryyan, que permitió dos de los autores independientemente incluir, excluir o estar indeciso, las discrepancias fueron resueltas por un tercero. Los artículos seleccionados se clasificaron según la Agency for Healthcare Research and Quality (AHRQ). Y para la interpretación de los resultados, los artículos se agruparon por semejanza y se categorizaron de la siguiente manera: autor, año, país, nivel de evidencia, objetivos y resultados, conclusión y recomendación. Resultados se identificaron 415 estudios y se incluyeron 10 en la revisión. El resultado principal obtenido fue el tratamiento tópico de la úlcera, las vulnerabilidades y los determinantes que asolaron a los afectados por la lepra no fueron estudiados. Conclusión no hay fuertes evidencias sobre las terapias para el tratamiento de úlceras de piernas resultantes de la lepra que justifiquen la reducción de secuelas incapacitantes provocadas por la enfermedad, perpetuando el estigma y la desigualdad social.

Abstract Objective To investigate the scientific evidence on leg ulcers as leprosy sequel. Methods This is an Integrative Literature Review (ILR). In order to identify the theme and research question, the PICo strategy was used, in the sequence the search was carried out in Index to Nursing and Allied Health Literature (CINAHL), Latin American & Caribbean Literature in Health Sciences (LILACS), (BDENF), EMBASE (Elsevier), PUBMED (National Library of Medicine), SCOPUS (Elsevier), Web of Science (Clarivate Analytics) databases. Specific descriptors were selected for each of them and respective search strategies were created. The languages considered were English, Portuguese and Spanish. The ILR period was indeterminate. For the study selection, the Ryyan tool was used and allowed two of the authors to independently include, exclude or remain undecided, disagreements were solved by a third party. The selected articles have been ranked according to the Agency for Healthcare Research and Quality (AHRQ). And for interpretation of results, the articles were grouped by similarity and categorized into author, country year, level of evidence, objectives and results, conclusion and recommendation. Results 415 studies were identified and 10 were included in the review. The main outcome was the topical treatment of ulcers, the vulnerabilities and the determinants that afflict those affected by leprosy were not studied. Conclusion There is no strong evidence on therapies for the treatment of leprosy-induced leg ulcers that support the reduction of disabling sequel caused by disease perpetuating stigma and social inequality.

Hanseníase: graves consequências do diagnóstico tardio: relatos de dois casos e breve abordagem sobre suas sequelas / Leprosy: severe consequences of late diagnosis: reports of two cases and brief approach on its sequels

Hanseníase é doença infectocontagiosa de grande relevância para o Brasil. País que juntamente com a Índia e a Indonésia, notificam 81% dos novos casos mundialmente. Provocam desde lesões em pele até graves lesões em olhos, nervos periféricos, endotélio vascular, ossos e articulações, implicando em importantes sequelas e consequências psicossociais. O diagnóstico precoce dos casos interrompe a cadeia epidemiológica de transmissão da doença e diminui consideravelmente o risco de incapacidade. Relataremos 2 casos de hanseníase em fases avançadas, incapacitantes e transmissíveis, cujo estigma das deformidades, levou ao autoisolamento retardando a procura por diagnóstico(AU).

Leprosy is an infectious contagious disease of great relevance to Brazil, which together with India and Indonesia, report 81% of new cases worldwide. They cause from skin lesions to severe lesions in eyes, peripheral nerves, vascular endothelium, bones, and joints, implying important sequelae and psychosocial consequences. Early diagnosis of cases interrupts the epidemiological transmission chain of the disease and decreases considerably the risk of incapacity. We will report two cases of leprosy in advanced stages, incapacitating and transmissible, whose stigma of deformities led to self-isolation, delaying the search for diagnosis(AU).

Lobomycosis and squamous cell carcinoma / Lobomicose e carcinoma espinocelular

The occurence of squamous cell carcinoma on long-lasting ulcers is classic. Malignant transformation may occur on burn scars and chronic ulcers of varying etiology, including infectious agents. Transformation of old lobomycosis lesion scars into squamous cell carcinoma has been rarely reported. Careful and long-term follow-up of such patients is important to avoid carcinomatous transformation.

A ocorrência de carcinoma espinocelular sobre lesões cutâneas de longa evolução é clássica em cicatrizes de queimadura e úlceras crônicas de etiologia variada, inclusive infecciosa. Na literatura, são raros os casos de pacientes com lobomicose de longa evolução que desenvolveram CEC. O seguimento cuidadoso desses pacientes é importante, pois, nas áreas de traumas, ulcerações e cicatrizes crônicas pode ocorrer degeneração carcinomatosa. .

Úlceras cutâneas na hanseníase: perfil clínico-epidemiológico dos pacientes / Skin ulcers in leprosy: clinical and epidemiological characteristics of patients

FUNDAMENTOS: A hanseníase é uma doença de evolução crônica cuja lesão nervosa determina alterações sensitivas e motoras, levando à instalação de deformidades assim como as úlceras cutâneas. OBJETIVO: Traçar perfil epidemiológico dos hansenianos ulcerados e não ulcerados atendidos no Hospital das Clínicas de Ribeirão Preto 2003/2004. MÉTODOS: Estudo transversal de 79 hansenianos atendidos em 2003 e 2004 junto ao Arquivo Médico, separando-os em Grupo 1 RESULTADOS: Nesta amostra, 69,6 por cento eram do sexo masculino, 91,1 por cento brancos e baciloscopia positiva em 62 por cento. Destes, 25 (32 por cento) pacientes apresentaram ulcerações (Grupo 1) localizadas nos membros inferiores em 68 por cento dos casos, classificados como grau II de incapacidade (72 por cento), diferente em relação ao grupo 2 (p<0,01). Na classificação espectral da hanseníase, comparando os pares de grupos observaram-se diferenças entre tuberculóide e virchowiano (p<0,01), dimorfo e dimorfo-virchowiano (p<0,05), e este com virchowiano (p<0,01). Na operacional, 80 por cento dos ulcerados eram multibacilares enquanto 12 por cento paucibacilares (p<0,05). CONCLUSÕES: Os Grupos 1 e 2 foram epidemiologicamente semelhantes. As ulcerações dos hansenianos parecem estar relacionadas ao grau II de incapacidade e à positividade da baciloscopia, características detectadas por ambas as classificações (espectral e operacional).

BACKGROUND: Leprosy is a chronic disease and its complications include neural lesions, which may cause motor and sensitive changes, leading to deformities as well as skin ulcers. OBJECTIVE: To show the epidemiological profile of leprosy patients with ulcerated and non-ulcerated lesions, seen at the Hospital das Clínicas de Ribeirão Preto. METHODS: A cross-section study of the medical charts of 79 leprosy patients seen at the hospital in 2003/2004. Patients were classified into Group 1 (ulcerated lesions) and Group 2 (non-ulcerated lesions) based on their clinical and epidemiological characteristics. RESULTS: In this sample, 69.6 percent were male, 91.1 percent white and positive bacilli were found in 62 percent. Among them, 25 (32 percent) presented skin ulcers (Group 1) located on the lower limbs in 68 percent of cases, classified as disability grade II (72 percent), as compared to group 2 (p<0.01). Based on spectral leprosy classification, there were differences between tuberculoid and lepromatous (p<0.01), borderline and borderline lepromatous (p<0.05) and between the latter one and lepromatous form (p<0.01). As to the operational classification, 80 percent of patients with ulcers were multibacillary and 12 percent were paucibacillary (p<0.05). CONCLUSION: Groups 1 and 2 were epidemiologically similar. The ulcerated skin lesions seem to be related to disability grade II and to positive bacilli detected by both spectral and operational classifications.