RESUMO
We report a 52 year-old woman with a past history of lepromatous leprosy (14 years prior to our first evaluation) who presented with progressive weakness and severe arm/leg pain. CSF analysis revealed elevated protein level with normal cell count. Skin and sural nerve biopsy showed no bacilli. Immunomodulatory treatment led to major improvement on clinical, CSF and electrodiagnostic grounds, but after one year of treatment, skin test revealed leprosy relapse. To our knowledge, this is the first report of a multifocal inflammatory neuropathy heralding leprosy relapse. Extended neurological work-up may be important in unexplained neuropathy progression after leprosy treatment.
Assuntos
Hanseníase Virchowiana/fisiopatologia , Debilidade Muscular/fisiopatologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Progressão da Doença , Feminino , Humanos , Imunoterapia , Hanseníase Virchowiana/líquido cefalorraquidiano , Hanseníase Virchowiana/tratamento farmacológico , Pessoa de Meia-Idade , Debilidade Muscular/líquido cefalorraquidiano , Debilidade Muscular/terapia , Doenças do Sistema Nervoso Periférico/líquido cefalorraquidiano , Doenças do Sistema Nervoso Periférico/terapia , Recidiva , Pele/microbiologia , Pele/patologia , Nervo Sural/microbiologia , Nervo Sural/patologia , Fatores de Tempo , Resultado do TratamentoRESUMO
We present the clinical manifestations and morphological characteristics in a case from a patient with familial history of leprosy that presented peripheral neuropathy without cutaneous lesions. The nerves affected showed a loss of myelinated and unmyelinated fibers as well as chronic inflammatory infiltrate. The presence of Hansen's bacillus was demonstrated in macrophages, Schwann cells, endothelial cells, and fibroblasts at light and ultrastructural levels. In this case, the demonstration of the bacillus in the biopsy of peripheral nerve confirmed the diagnosis.
Assuntos
Hanseníase Tuberculoide/diagnóstico , Mycobacterium leprae/isolamento & purificação , Polineuropatias/microbiologia , Reações Falso-Negativas , Feminino , Humanos , Antígeno de Mitsuda , Hanseníase Tuberculoide/microbiologia , Pessoa de Meia-Idade , Parestesia/microbiologia , Parestesia/patologia , Polineuropatias/patologia , Nervo Sural/microbiologia , Nervo Sural/patologiaAssuntos
Antígeno de Mitsuda , Hanseníase Tuberculoide/diagnóstico , Hanseníase Tuberculoide/microbiologia , Mycobacterium leprae/isolamento & purificação , Nervo Sural/microbiologia , Nervo Sural/patologia , Parestesia/microbiologia , Parestesia/patologia , Polineuropatias , Reações Falso-Negativas , Relatos de Casos , Resumo em InglêsRESUMO
We have introduced the periodic acid-ethanol gelatin methenamine silver stain for the simultaneous demonstration of Mycobacterium leprae and myelin in the peripheral nerves of leprosy patients.
Assuntos
Hanseníase/microbiologia , Mycobacterium leprae/isolamento & purificação , Bainha de Mielina/patologia , Fibras Nervosas/microbiologia , Pele/inervação , Nervos Espinhais/microbiologia , Nervo Sural/microbiologia , Etanol , Gelatina , Humanos , Hanseníase/patologia , Metenamina , Fibras Nervosas/patologia , Ácido Periódico , Coloração e Rotulagem , Nervo Sural/patologiaRESUMO
The clinical and neuropathological findings an a patient with "neuritic" leprosy are described. In this rare form of leprosy, skin changes are only minimal or absent anf the diagnosis can be established only by nerve biopsy
Assuntos
Hanseníase Tuberculoide/classificação , Hanseníase Tuberculoide/complicações , Hanseníase Tuberculoide/diagnóstico , Hanseníase Tuberculoide/patologia , Neuritos/complicações , Neuritos/diagnóstico , Neuritos/etiologia , Neuritos/patologia , Córnea/metabolismo , Córnea/microbiologia , Nervo Sural/anatomia & histologia , Nervo Sural/cirurgia , Nervo Sural/lesões , Nervo Sural/microbiologia , Nervo Sural/patologiaRESUMO
This study elicits the comparative evaluation of the Bacteriologic Index (BI) and Morphologic Index (MI) of the skin, lymph node, bone marrow, nerve and muscle tissues of 15 untreated leprosy patients. The findings of comparable or even higher BI's and MI's in lymph nodes than skin are of considerable interest, especially the presence of a significant percentage of viable bacilli during reaction states when MI of skin and nerve tissue was found to be negative. Evaluation of the BI's and MI's of lymph nodes has been suggested to be of utmost importance for follow-up studies of patients being treated with antileprosy drugs.