Swollen hands and feet syndrome: An uncommon presentation of a common disease.

Leprosy is an infectious disease caused by M. leprae with predominant skin and neurological involvement. Although musculoskeletal involvement can occur in leprosy during the disease course, the first presentation of leprosy with musculoskeletal manifestation is relatively rare. Here we present a case that presented musculoskeletal manifestation as an initial feature.

Leprosy presenting as remitting seronegative symmetrical synovitis with pitting oedema syndrome - a case report.

BACKGROUND: Leprosy typically manifests with skin and peripheral nerve involvement. Musculoskeletal complaints are the third most common, and can be the sole presenting manifestation. They range from arthralgia/arthritis in reactional states to full mimics of systemic rheumatic diseases. Remitting Seronegative Symmetrical Synovitis with Pitting Oedema syndrome has only been described once in a patient with already diagnosed Leprosy. CASE REPORT: A 68-year-old male, from an endemic region of familial amyloid polyneuropathy, presented with an inaugural Remitting Seronegative Symmetrical Synovitis with Pitting Oedema like syndrome, more that 20 years after travelling to Leprosy endemic areas. Arthritis would resurface whenever oral prednisone was tapered, so methotrexate was started, controlling the complaints. Only one year later, after the appearance of peripheral neuropathy and skin lesions, it was possible to diagnose Leprosy, through the identification of Mycobacterium leprae bacilli in a peripheral nerve biopsy. CONCLUSION: This report is an example of the heterogeneity of manifestations of Leprosy, namely rheumatic, and the challenge of diagnosing it when typical complaints are absent. It is also a reminder that this disease should be considered whenever a patient with a combination of skin/neurologic/rheumatic complaints has travelled to endemic countries in the past.

Complications of laser and light-based devices therapy in patients with skin of color.

Lasers and light-based devices are indispensable to an aesthetic dermatology practice. The growing popularity of lasers has been matched by a sharp increase in the incidence of complications. The Indian skin with its high melanin content is more prone to injury and careful setting of laser parameters, early detection of complications and immediate therapy are vital to avoiding permanent sequelae. We review the various complications that occur during laser procedures and their management.

Leprosy with ANA positive mistaken for connective tissue disease.

Leprosy is associated with the occurrence of various skin lesions such as macules, papules, plaques, nodules, and even diffused infiltration, depending on the patient's immune response. Its clinical presentation is often different from the usual pattern, leading to confusion in diagnosis. We present a case of leprosy with ANA positive that was mistaken for connective tissue disease. In this case, we want to tell that doctors should not only depend on laboratory index for diagnosis, the misdiagnosis may lead to delaying illness and aggravating illness.

Deciphering spongiotic dermatitides.

Clinicians often receive pathology reports proclaiming a spongiotic dermatitis with little in the form of a cogent differential diagnosis. In some cases, this is a natural consequence of the nonspecific nature of the reaction pattern due to matters of sampling error and/or lesional evolution. Further, some conditions are so synonymous in their histologic presentation that to choose one without mention of the other, purely on a histologic basis, may serve to inadvertently mislead the clinician. Despite the often significant histologic overlap amongst the varying spongiotic dermatitides, there are many subtle, yet detectable, features that may serve as clues to the pathogenetic process. Identification and subsequent communication of these features help to narrow the diagnostic possibilities with the ultimate goal of contributing to effective patient management. This article focuses on the histologic details of the spongiotic reaction pattern and presents some of the more common variations of its manifestation which, in conjunction with ancillary inflammatory elements, may help the histomorphologist to arrive at a more concise list of diagnostic possibilities.

[Edema in leprosy: the clinical and therapeutic aspects]. / Edema na hanseníase: aspectos clínicos e terapêuticos.

Edema, which is commonly described as a symptom of reactional states, may occur during the course of leprosy. Both diagnosis and adequate treatment measures are often difficult to achieve and failure to do so may result in permanent damage to the lower limbs. In a one-year follow-up study of leprosy patients--ten multibacillary and one paucibacillary--who had been submitted to a clinical protocol for diagnosis and pathological classification, a clinical pattern of localized and/or systemic edema was observed. Among these patients, five simultaneously presented other symptoms related to reactional states, 4 were diagnosed as Type I, and one as Type II. On the other hand, while three of the patients did not present reaction at the time when edema was diagnosed, they did develop some aspects of reactional disease later on (two had neuritis e one had Type I reaction). The edemas that preceded or were associated with reactional episodes showed clinical regression as a result of specific treatment against reactions (corticosteroids and/or pentoxifylline and/or thalidomide) in the absence of another treatment normally used for edemas. Although these data need to be confirmed by controlled studies, they strongly suggest that immunological mechanisms are involved in the physiopathology of edema in leprosy.

Edema na hanseníase: aspectos clínicos e terapêuticos / Edema in leprosy: clinical and therapeutical aspects

Durante o curso da hanseníase, o edema comumente descrito como um sintoma de estados reacionais, pode ocorrer. Tanto o diagnóstico como a terapêutica adequada säo, freqüentemente, difíceis de conseguir e assim podem acarretar permanente dano aos membros inferiores. Em um ano de acompanhamento, pacientes hansenianos - 10 multibacilares e 1 paucibacilar -, que foram submetidos a um protocolo clínico para o diagnóstico e classificaçäo histopatológica, apresentaram clinicamente edema, localizado ou sistêmico. Entre estes pacientes, cinco apresentaram simultaneamente outros sintomas de reaçäo, 4 foram classificados como reaçäo Tipo I e um como reaçäo tipo II. Por outro lado, três pacientes näo apresentaram reaçäo no momento do diagnóstico, mas desenvolveram alguns aspectos de reaçäo posteriormente (2 tiveram neurite e um teve reaçäo tipo I). Os edemas observados precedendo ou associados a quadros reacionais apresentaram ótima resposta clínica às drogas de açäo anti-inflamatória (corticóide, talidomida e pentoxifilina) utilizadas para o tratamento dos estados reacionais, na ausência de qualquer outro tratamento normalmente usado para edema. Embora necessitem ser confirmados por estudos controlados, estes dados sugerem fortemente que mecanismos imunológicos estejam envolvidos na fisiopatologia dos edemas na hanseníase

Case of suspected connective tissue disease presenting as chronic edema or swelling of face, neck, and upper trunk.

An adequate biopsy that includes the subcutaneous tissue is very helpful in the evaluation of patients with suspected connective tissue disease. However, the histologic features must often be correlated with the clinical features and other laboratory tests for a definitive diagnosis. An objective histologic diagnosis can usually be made in scleroderma, lupus erythematosus panniculitis, amyloidosis, and angioedema, and in diseases such as lepromatous leprosy and mycosis fungoids (which are sometimes confused with connective tissue diseases). Correlation with clinical features and, sometimes, other laboratory tests is often required to establish a diagnosis of scleredema, dermatomyositis, myxedema, and lichen myxedematosus. The features in cheilitis granulomatosa usually are not specific, but a biopsy is helpful to rule out other diseases.