RESUMO
PURPOSE: Leprosy is rarely seen in Taiwan. We herein report a foreign worker concomitantly with facial borderline tuberculoid leprosy presenting with trigeminal neuralgia. CASE REPORT: A 26-year-old male foreign labor from Indonesia, presented with 1 year history of a hypoanaesthetic erythematous plaque of right face and subsequent 6 months constant, severe pain in the right side of his face over the nasolabial groove. Biopsies and histopathological examination confirmed the diagnosis of leprosy. We treated the patient with a multidrug regimen including dapsone, clofazimine, and rifampine since April of 2012 with a good response. CONCLUSIONS: We report a rare case of new-onset leprosy presenting with trigeminal neuralgia in Taiwan and suggest leprosy should be listed in the differential diagnosis of unusual skin manifestations and neuralgia.
Assuntos
Face/patologia , Hanseníase/complicações , Neuralgia do Trigêmeo/etiologia , Adulto , Quimioterapia Combinada , Granulomatose Orofacial/etiologia , Humanos , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Masculino , Proteínas S100/metabolismo , TaiwanRESUMO
This article reports an unusual case of neuropathic orofacial pain secondary to leprosy. To the authors' knowledge, it is the first case of leprosy reported in the Western literature that was initially thought to be dental pain, then mistaken as a temporomandibular disorder before the correct diagnosis was made. The patient had migrated to Australia from India 24 years previously and was otherwise healthy without any overt features suggestive of infection. A review of the literature revealed that the trigeminal nerve is frequently involved in leprosy, usually associated with sensory loss rather than neuropathic pain. Even in Western countries, patients originally from countries where leprosy is endemic may develop symptoms of the disease many years later. The possibility of leprosy should be considered in the diagnosis of neuropathic orofacial pain in such patients.
Assuntos
Dor Facial/etiologia , Hanseníase/diagnóstico , Neuralgia do Trigêmeo/etiologia , Biópsia , Tomografia Computadorizada de Feixe Cônico , DNA Bacteriano/análise , Diagnóstico Diferencial , Feminino , Humanos , Hanseníase/complicações , Hanseníase/tratamento farmacológico , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Mycobacterium leprae/genética , Transtornos da Articulação Temporomandibular/diagnóstico , Neuralgia do Trigêmeo/microbiologiaRESUMO
Leprosy is a granulomatous disease primarily affecting the skin and peripheral nerves caused by Mycobacterium leprae, but also significantly involving sinonasal cavities and cranial nerves. It continues to be a significant public health problem, and despite multidrug therapy, it can still cause significant morbidity. The awareness of cranial nerve, intracranial and orbital apex involvement as in our case is important for appropriate treatment measures.
Assuntos
Hanseníase Virchowiana/complicações , Doenças Orbitárias/microbiologia , Seios Paranasais/microbiologia , Neuralgia do Trigêmeo/microbiologia , Idoso de 80 Anos ou mais , Progressão da Doença , Seguimentos , Humanos , Imageamento Tridimensional , Hanseníase Virchowiana/diagnóstico , Hanseníase Virchowiana/tratamento farmacológico , Imageamento por Ressonância Magnética/métodos , Masculino , Mycobacterium leprae/isolamento & purificação , Doenças Orbitárias/diagnóstico , Índice de Gravidade de Doença , Síndrome , Tomografia Computadorizada por Raios X/métodos , Neuralgia do Trigêmeo/diagnósticoRESUMO
Trigeminal trophic syndrome is a rare condition resulting from self-manipulation of the skin after a peripheral or central injury to the trigeminal system. The syndrome consists of a classic triad of anaesthesia, paraesthesia, and a secondary persistent or recurrent facial ulceration. We describe a 60 year-old woman who developed this syndrome as a sequel to the gasserian ganglion block for trigeminal neuralgia. She had also developed melasma within 1 year. A remarkable benefit was achieved by proper patient education and topical antibiotics which led to the healing of all ulcerations within 4 weeks. In the case reported here, the diagnosis of the trigeminal trophic syndrome was made primarily as a result of the physician's experience with the syndrome previously.
Assuntos
Parestesia/diagnóstico , Úlcera Cutânea/diagnóstico , Antibacterianos/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Úlcera Cutânea/tratamento farmacológico , Síndrome , Neuralgia do Trigêmeo/cirurgiaRESUMO
A hanseníase é uma doença infecto-contagiosa, que além de alterações dermatológicas, possui manifestações neurológicas. Relatamos o caso de um homem de 66 anos, que apresentou nevralgia do trigêmeo após ter apresentado quadro de hanseníase.
Hansen's disease is an infectious disease that presents with skin changes, as well as neurological features. We report a case of a 66 years man, who presented with trigeminal neuralgia after developing Hansen's disease.
Assuntos
Humanos , Masculino , Idoso , Dor Facial , Hanseníase/complicações , Hanseníase/diagnóstico , Neuralgia do Trigêmeo/etiologia , Neuralgia do Trigêmeo/tratamento farmacológico , Brasil , Doenças Transmissíveis , Carbamazepina/uso terapêutico , Nervos PeriféricosAssuntos
Dermatite/diagnóstico , Higiene da Pele/métodos , Dermatite/etiologia , Dermatoses Faciais/diagnóstico , Dermatoses Faciais/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Negligenciadas/diagnóstico , Doenças Negligenciadas/etiologia , Medição da Dor , Remissão Espontânea , Medição de Risco , Índice de Gravidade de Doença , Higiene da Pele/efeitos adversos , Neuralgia do TrigêmeoRESUMO
Trigeminal neuralgia is a well recognized clinical entity. However, it has not been reported to mimic leprosy or vice versa. Of the 3 cases reported here, 2 initially presented with neuralgic symptoms similar to that seen in trigeminal neuralgia and later developed borderline lesions on the face. The 3rd case demonstrated a tingling sensation along with firm and palpable supraorbital nerve (a branch of trigeminal nerve), and a very early skin lesion on the face pointed to the need to consider neuritic type leprosy before concluding the final diagnosis of a disease like trigeminal neuralgia which calls for a different therapeutic approach.