Frequent testicular involvement in multibacillary leprosy.

OBJECTIVE: Testicular involvement or atrophy in leprosy is silent, unreported, and under-estimated. The aim of this study was to assess the frequency of testicular atrophy and its consequences through the examination of clinical manifestations, hormonal profile, and semen analysis in leprosy patients. METHODS: A descriptive observational study using a cross-sectional design and consecutive sampling method was conducted from May to July 2018. The study was conducted in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia and included 32 men affected by leprosy and five healthy men as a control group. All patients were subjected to history-taking, dermatological and genital examinations, assessment of follicle-stimulating hormone (FSH), luteinizing hormone (LH), and testosterone, and testicular ultrasonography examination. Semen analysis was performed for the 10 patients who consented. RESULTS: Testicular atrophy was observed in 93.75% of patients. Clinical manifestations of testicular atrophy were loss of libido (21.87%), female pubic hair pattern (9.38%), gynecomastia (6.25%), and secondary infertility (6.25%). Hormonal imbalance was seen in 16 patients, and all 10 patients who underwent semen analysis showed an abnormality. CONCLUSIONS: This study showed a high frequency of testicular atrophy, but the symptoms were only present in a few of patients. The assessment of testicular function should be recommended as a routine work-up for leprosy patients.

Diagnostic delay in a patient with reactional lepromatous leprosy treated as testicular tuberculosis.

Leprosy is a chronic neglected and stigmatizing disease. Due to involvement of the peripheral nerves, it can result in physical disabilities, deformities, and emotional damage if not diagnosed and treated promptly. This is the case of a young patient with testicular pain and swelling and no improvement after a specific therapeutic scheme for tuberculosis. Clinical and laboratory reevaluation revealed hypoesthetic skin patches associated with post-burn crusted ulcers on the left arm, thickening of ulnar nerves, atrophy of interosseous muscles of the hands, positive skin smear microscopy, and testicular histopathology with numerous bacilli forming globi. These findings indicated lepromatous leprosy with type II reaction.

Diagnostic delay in a patient with reactional lepromatous leprosy treated as testicular tuberculosis

Abstract Leprosy is a chronic neglected and stigmatizing disease. Due to involvement of the peripheral nerves, it can result in physical disabilities, deformities, and emotional damage if not diagnosed and treated promptly. This is the case of a young patient with testicular pain and swelling and no improvement after a specific therapeutic scheme for tuberculosis. Clinical and laboratory reevaluation revealed hypoesthetic skin patches associated with post-burn crusted ulcers on the left arm, thickening of ulnar nerves, atrophy of interosseous muscles of the hands, positive skin smear microscopy, and testicular histopathology with numerous bacilli forming globi. These findings indicated lepromatous leprosy with type II reaction.

[Leprosy and the testis]. / La lepra y el testículo.

INTRODUCTION: Damage of testicles is frequent in lepromatous leprosy and worsened by the presence of erythema nodosum leprosum. Objective. A patient is presented who developed lepromatous leprosy and erythema nodosum leprosum with major testicular compromise. MATERIAL AND METHODS: The 28-year-old male patient had lepromatous leprosy since age 22. During a polychemotherapy treatment for the lepromatous leprosy, he presented chronic erythema nodosum leprosum that affected both testicles; he did not respond to the conventional treatment. A left orchidectomy was performed to treat the persistent pain. RESULTS: The extracted testis evidenced the following: tubular atrophy, extensive fibrosis, cumulus of foamy macrophages without rods, focal Leydig cell hyperplasia, linfocitary and granulomatous arteritis and endarteritis of small and medium size vessels. These changes were also observed in the epididymis. Two years after the polychemoterapy and the orchidectomy, the patient exhibited azoospermy, normal total testosterone, slightly diminished free testosterone and elevated levels of luteinizing hormone and follicle-stimulating hormone. No loss of libido or sexual activity was reported. General concepts of erythema nodosum leprosum were reviewed, as well as the pathologic changes produced by leprosy in the testis. CONCLUSION: Lepromatous leprosy may lead to hypogonadism. This condition is recommended for inclusion in leprosy diagnostic programs in order to detect and treat the consequences of the possible hypogonadism.

La lepra y el testículo / Leprosy and the testis

Introducción. La afección testicular es frecuente en la lepra lepromatosa, daño que se incrementa cuando cursa con eritema nudoso leproso. Objetivo. Presentar un paciente con lepra lepromatosa y eritema nudoso leproso con grave compromiso testicular. Materiales y métodos. Se estudió un hombre de 28 años con lepra lepromatosa desde los 22, que durante la poliquimioterapia para la lepra presentó eritema nudoso leproso crónico que afectó ambos testículos y no respondió al manejo convencional. El dolor persistente obligó a practicar orquidectomía izquierda. Resultados. Este testículo presentaba atrofia tubular y fibrosis notorias, conglomerados de macrófagos espumosos, sin bacilos, hiperplasia focal de células de Leydig, endarteritis y arteritis linfocitaria y granulomatosa de vasos pequeños y medianos; estos cambios también estaban presentes en el epidídimo. Un estudio llevado a cabo dos años después de terminar su tratamiento y de la orquidectomía izquierda, demostró azoospermia, testosterona total normal, testosterona libre discretamente disminuida y hormonas lutropina (luteinizante) y folitropina (estimulante del folículo) elevadas. No había disminución de la libido ni de su actividad sexual. Se revisaron los conceptos generales sobre el eritema nudoso leproso y las alteraciones que la lepra produce en el testículo. Conclusión. La lepra lepromatosa puede conducir a hipogonadismo. Los programas de lepra deben contemplar esta complicación para corregir y evitar sus secuelas.

Introduction. Damage of testicles is frequent in lepromatous leprosy and worsened by the presence of erythema nodosum leprosum. Objective. A patient is presented who developed lepromatous leprosy and erythema nodosum leprosum with major testicular compromise. Material and methods. The 28-year-old male patient had lepromatous leprosy since age 22. During a polychemotherapy treatment for the lepromatous leprosy, he presented chronic erythema nodosum leprosum that affected both testicles; he did not respond to the conventional treatment. A left orchidectomy was performed to treat the persistent pain. Results. The extracted testis evidenced the following: tubular atrophy, extensive fibrosis, cumulus of foamy macrophages without rods, focal Leydig cell hyperplasia, linfocitary and granulomatous arteritis and endarteritis of small and medium size vessels. These changes were also observed in the epididymis. Two years after the polychemoterapy and the orchidectomy, the patient exhibited azoospermy, normal total testosterone, slightly diminished free testosterone and elevated levels of luteinizing hormone and follicle-stimulating hormone. No loss of libido or sexual activity was reported. General concepts of erythema nodosum leprosum were reviewed, as well as the pathologic changes produced by leprosy in the testis. Conclusion. Lepromatous leprosy may lead to hypogonadism. This condition is recommended for inclusion in leprosy diagnostic programs in order to detect and treat the consequences of the possible hypogonadism.

Hypogonadal osteoporosis in elderly male patients with lepromatous leprosy.

Geriatric diseases have become significant problems in Japanese leprosariums. In particular, male osteoporosis seems to be more frequent in elderly leprosy patients than in non-leprosy elders. In 1987 we measured the cortical thickness of the 2nd metacarpal bone (MCI: metacarpal index) in 499 leprosy patients who were under medical treatment for osteoporosis. Of these patients, 139 were female patients with lepromatous leprosy (FL), 58 were female patients with tuberculoid leprosy (FT), 238 were male patients with lepromatous leprosy (ML) and the remaining 64 were male patients with tuberculoid leprosy (MT). The results were that the MCI of 238 ML was lower than 139 FL in the 4th, 5th 6th, and 7th decade of life. Furthermore the decreasing ratio of MCI peaked in the 4th decade was 70.6% between the ages of the 8th decade in ML. We conclude that this is a manifestation of leprosy-specific osteoporosis, which is associated with testicular dysfunction in elderly male patients with lepromatous leprosy.

A comparative study of testicular involvement in lepromatous and borderline lepromatous leprosy.

To measure the comparative prevalence of testicular involvement in borderline lepromatous (BL) and lepromatous (LL) leprosy patients, serum FSH, LH, and total testosterone levels were measured in 42 LL and 21 BL subjects. Serum FSH levels were elevated in 19% of BL and in 86% of LL patients. Serum LH values were increased in 10% of BL and in 79% of LL patients. Total serum testosterone values below the normal limit of 280 ng/dl were not found in BL subjects but were present in 31% (13) of the LL cases. By measuring serum free testosterone in patients with low-normal total values, one BL and an additional five LL patients could be identified as below normal limits, i.e., less than 50 pg/ml. Thus, androgen deficiency was present in 5% of BL and in 43% of LL subjects. All of these differences between the BL and LL patients were statistically significant.

Gonadal involvement in leprosy--study of gynaecomastia, testicular and epididymal involvement and therapeutic efficacy of indigenous drugs.

Sixty male patients of leprosy (mean age = 27.2 +/- 5.04 years) selected at random, were studied for gonadal involvement and therapeutic efficacy of two indigenous drugs. Of these 34 were married, with the mean duration of illness 4.17 +/- 3.27 years. Only those with lepromatous and dimorphous leprosy developed testicular and epididymal changes. Testicular pain and/or swelling (lepromatous = 62.5%, dimorphous = 30%) was the commonest presenting feature. Altered sexual function was observed in 34 (56.6%) cases, while 11 patients revealed altered sexual hair pattern and nine gynaecomastia. Reduced testicular size associated with soft feel was present in 25% of cases with no testicular sensation in 8 (13.3%) and impaired testicular sensation in 9 (15%) patients. Spermogram revealed azoospermia in 19 (35%) and oligospermia in 16 (26.6%) patients. Histopathological findings of testicle biopsy revealed evidence of leprous pathological irrespective of testicular size, semen picture and clinical manifestations. Histopathological changes had shown marked variation and so did not enable categorising them into vascular, interstitial and obliterative phases. These changes were believed to be due to the altered gonadal state in leprosy. The therapeutic efficacy of the indigenous preparations, Speman and Tentex forte (Himalaya) was evaluated subjectively as well as objectively in 34 patients. 82.3% of cases showed subjective improvement while objective improvement in spermogram was noted in 87.5% cases with oligospermia. The drugs have no side effect and were well tolerated.

Hormonal changes associated with testicular atrophy and gynaecomastia in patients with leprosy.

Basal LH, FSH, 17 beta-oestradiol and testosterone and the gonadotrophin responses to luteinizing hormone releasing hormone (LHRH) were studied in male patients with leprosy (twenty-four with lepromatous and six with tuberculoid leprosy). The mean basal LH and FSH was significantly elevated in the lepromatous group and was associated with an excessive response of both gonadotrophins following LHRH administration. The mean basal testosterone and 17 beta-oestradiol values in the lepromatous group were significantly lower than those of the tuberculoid and control groups. The abnormal gonadotrophin and sex steroid values in the lepromatous group are in keeping with the testicular atrophy and gynaecomastia accompanying this form of leprosy. However, the lack of a significant correlation between basal FSH and testicular atrophy should be noted. In addition, no correlation between any of these hormonal values and gynaecomastia could be demonstrated. The patients with tuberculoid leprosy had essentially normal hormonal profiles (except for two who had raised 17 beta-oestradiol values). This is compatible with the lack of gonadal involvement in these patients.

Hormonal changes associated with testicular atrophy and gynaecomastia in patients with leprosy

Basal LH, FSH, 17 beta-oestradiol and testosterone and the gonadotrophin responses to luteinizing hormone releasing hormone (LHRH) were studied in male patients with leprosy (twenty-four with lepromatous and six with tuberculoid leprosy). The mean basal LH and FSH was significantly elevated in the lepromatous group and was associated with an excessive response of both gonadotrophins following LHRH administration. The mean basal testosterone and 17 beta-oestradiol values in the lepromatous group were significantly lower than those of the tuberculoid and control groups. The abnormal gonadotrophin and sex steroid values in the lepromatous group are in keeping with the testicular atrophy and gynaecomastia accompanying this form of leprosy. However, the lack of a significant correlation between basal FSH and testicular atrophy should be noted. In addition, no correlation between any of these hormonal values and gynaecomastia could be demonstrated. The patients with tuberculoid leprosy had essentially normal hormonal profiles (except for two who had raised 17 beta-oestradiol values). This is compatible with the lack of gonadal involvement in these patients.

Testicular and epididymal involvement in leprosy patients, with special reference to gynecomastia

Sixty-six male patients with leprosy were studied. Only those with the lepromatous type developed testicular and epididymal changes. Nine of the 38 patients showed decreased sexual function, and 7 developed gynecomastia. These changes were believed to be due to the altered gonadal state.

Testicular and epididymal involvement in leprosy patients, with special reference to gynecomastia.

Sixty-six male patients with leprosy were studied. Only those with the lepromatous type developed testicular and epididymal changes. Nine of the 38 patients showed decreased sexual function, and 7 developed gynecomastia. These changes were believed to be due to the altered gonadal state.

Rôle du blocage lymphatique spermatique dans les lesions testiculaires de la lépre lepromateuse avec gynecomastie / Role of spermatic lymphatic obstruction in the testicular lesions of lepromatous leprosy with gynecomastia

Clinical, biological and pathological study of seven negro male patients suffering from lepromatous with gynecomastia. On biopsy microscopic sections of the tests has been shown an important interstitial edema suggesting lymphatic stasis. Spermatic lymphographies show in every case a clogging which can be considered as an additional factor of testicular disorder..