Bullous erythema nodosum leprosum manifesting in the post partum period with unusual features.

A 30 year old woman who presented with multiple numb patches on the body was initially diagnosed as borderline lepromatous leprosy and started on multidrug therapy for leprosy. She had an episode of Type 1 reaction during the fifth month of pregnancy. After delivery, she stopped therapy fearing harm to her child and developed an episode of Type 2 reaction. The reaction was unusual in that bullous lesions developed over previous leprosy patches which had initially become indurated, with associated neuritis. Histopathology revealed bullae with intense neutrophilic reaction and strong positivity for acid fast bacilli. There was no response to steroid therapy which was started for the reaction. Thalidomide had to be prescribed after stopping lactation by medical means. She responded dramatically to Thalidomide with regression of cutaneous lesions and neuritis. This patient is being reported as a very unusual manifestation of bullous erythema nodosum leprosum in the postpartum period responding dramatically to thalidomide.

Ciclo gravídico puerperal associado às reações hansênicas: um olhar pela enfermagem / Pregnancy-puerperal cycle associated with leprosy reactions: a nursing perspective / Ciclo embarazo-puerperio asociado a reacciones leprosas: una perspectiva de enfermería

Objetivo: analisar as possíveis reações hansênicas que interferem no ciclo gravídico puerperal. Método: estudo exploratório, quanti-qualitativo, participando oito mulheres portadoras e ex-portadoras de hanseníase que engravidaram antes, durante ou depois do diagnóstico da doença, cujos dados foram obtidos por meio de entrevistas com roteiro semiestruturado e pesquisa em prontuários. Este estudo teve o projeto de pesquisa aprovado pelo Comitê de Ética em Pesquisa, CAEE nº 25000.196371/2011-70. Resultados: após análise dos dados emergiram cinco categorias: conhecimentos sobre a doença; reação frente ao diagnóstico; sentimentos acerca do preconceito; descoberta da gravidez associada ao diagnóstico da hanseníase; e reações hansênicas. Conclusão: houve exacerbação da sintomatologia da hanseníase e desenvolvimento de reações hansênicas em mulheres no ciclo gravídico puerperal.(AU)

Objective: to assess the possible leprosy reactions that interfere in the pregnancy-puerperal cycle. Method: exploratory, quantitative, and qualitative study conducted with eight female leprosy and former leprosy patients who got pregnant before, during, or after the diagnosis of the disease, whose data were collected through semi-structured interviews and survey in medical records. The research project was approved by the Research Ethics Committee, CAEE No. 25000.196371/2011-70. Results: after the analysis of the data, five categories emerged: knowledge about the disease; response to the diagnosis; feelings about prejudice; discovery of pregnancy associated with the diagnosis of leprosy; and leprosy reactions. Conclusion: there was exacerbation of leprosy symptoms and development of leprosy reactions in women during the pregnancypuerperal cycle.(AU)

Objetivo: analizar las posibles reacciones leprosas que interfieren en el ciclo embarazo-puerperio. Método: estudio exploratorio, cuantitativo y cualitativo llevado a cabo con ocho mujeres portadoras y ex portadoras de lepra que quedaron embarazadas antes, durante o después del diagnóstico de la enfermedad, cuyos datos fueron recogidos a través de entrevistas semiestructuradas e investigación en registros médicos. El proyecto de investigación fue aprobado por el Comité de Ética en Investigación, CAEE Nº 25000.196371/2011-70. Resultados: después del análisis de los datos surgieron cinco categorías: conocimiento acerca de la enfermedad; reacción frente al diagnóstico; sentimientos acerca de prejuicios; descubrimiento del embarazo asociado con el diagnóstico de la lepra; y reacciones leprosas. Conclusión: hubo exacerbación de los síntomas de la lepra y desarrollo de reacciones leprosas en mujeres durante el ciclo embarazo-puerperio.(AU)

Neuropatía hanseniana en una adulta joven / Hansenian neuropathy in a young adult

Se presenta el caso de una paciente de 27 años de edad, sin previos antecedentes, que en el período de puerperio comenzó a presentar deterioro neurológico progresivo, dificultad para la marcha, graves trastornos sensitivos, del tipo de las parestesias y artralgias, pérdida de la sensibilidad propioceptiva, al tacto, al dolor, a la temperatura y en zonas dístales de miembros inferiores, además de manchas violáceas en tórax, abdomen y rodillas. En la muestra para biopsia se encontró un patrón inflamatorio compatible con lepra lepromatosa.

The case of a 27 year-old patient without previous history is reported, who in the puerperium began to present with progressive neurological deterioration, difficult walking, serious sensitive conditions such as paresthesia and arthralgia, loss of the proprioceptive sensibility to the tact, pain, temperature and in distal areas of inferior extremities besides violaceuos plaques in thorax, abdomen and knees. In the biopsy sample an inflammatory pattern consistent with lepromatous leprosy was found.

Neuropatía hanseniana en una adulta joven / Hansenian neuropathy in a young adult

Se presenta el caso de una paciente de 27 años de edad, sin previos antecedentes, que en el período de puerperio comenzó a presentar deterioro neurológico progresivo, dificultad para la marcha, graves trastornos sensitivos, del tipo de las parestesias y artralgias, pérdida de la sensibilidad propioceptiva, al tacto, al dolor, a la temperatura y en zonas dístales de miembros inferiores, además de manchas violáceas en tórax, abdomen y rodillas. En la muestra para biopsia se encontró un patrón inflamatorio compatible con lepra lepromatosa(AU)

The case of a 27 year-old patient without previous history is reported, who in the puerperium began to present with progressive neurological deterioration, difficult walking, serious sensitive conditions such as paresthesia and arthralgia, loss of the proprioceptive sensibility to the tact, pain, temperature and in distal areas of inferior extremities besides violaceuos plaques in thorax, abdomen and knees. In the biopsy sample an inflammatory pattern consistent with lepromatous leprosy was found(AU)

Pregnancy and leprosy: a comprehensive literature review.

The interaction between pregnancy, leprosy and leprosy reactions was examined in a systematic literature review. Several retrospective case series and one retrospective cohort study but only one prospective cohort study were identified in the English literature. Type 1 (reversal) reactions were particularly likely to occur during the post partum. This temporal association was also present for both overt and silent neuritis. Type 2 (erythema nodosum leprosum) reactions occur throughout pregnancy and during lactation, and may be severe and recurrent. No prospective, controlled studies were found that documented the complications of pregnancy in women treated with multidrug therapy regimens. Our study highlights the need for such studies, with appropriate controls, on women throughout pregnancy and lactation so that risk factors for reaction and neuritis during pregnancy can be identified and quantified.

Hanseníase e gravidez / Leprosy and pregnancy

Foram estudadas vinte grávidas hansenianas do ponto de vista clínico [oito lepromatosas (L), sete borderline, quatro tuberculóide (T) e uma indeterminada (I)] e avaliados seus recém-nascidos. Três pacientes apresentaram os primeiros sintomas da doença durante uma das gestaçöes e outra no puerpério. Uma paciente teve a doença durante 16 anos e outra recebeu tratamento durante 14. O exame bacterioscópico foi positivo em 13 e negativo em sete. O teste de Mitsuda foi negativo em 16, positivo em duas, e em outras duas näo foi realizado. O esquema terapêutico em 14 pacientes foi poliquimioterapia (diaminodifenilsufona, rifampicina e clofazimina), a monoterapia (diaminodifenilsufona) foi realizada em três e nenhuma delas mostrou resistência a droga. Outras três só iniciaram o tratamento após o parto. Os estados reacionais foram tratados com corticosteróide e ácido acetilsalicítico. O uso de drogas foi realizado de modo irregular em nove pacientes e em oito regularmente. Em dez pacientes, observaram-se surtos reacionais: oito durante a gestaçäo, uma no puerpério e outra na lactaçäo. Oito apresentaram quadro de eritema nodoso leproso e duas reaçäo reversa, sendo que uma delas desenvolveu neurite ulnar no 2§ mês de gestaçäo. Uma paciente mostrou sorologia positiva para sífilis sem manifestaçöes clínicas da doença. Outra apresentou baciloscopia positiva durante a lactaçäo. Um recém-nato apresentou quadro de dermatite esfoliativa nas primeiras horas de vida e sua mäe tinha recebido diaminodifenilsufona durante a gravidez. Entre os 20 recém-natos, cinco tinham peso inferior a 2.500g e quatro eram prematuros. Nós concluímos que os estados reacionais das pacientes, o baixo peso e a prematuridade dos recém-natos ocorreram nas grávidas do grupo de lepromatosas e borderline

RO 15-1788 does not influence postpartum aggression in lactating female rats.

Recently, Hansen et al. (1985) suggested behavioural similarities between lactating rats and non-maternal rats treated with benzodiazepines (BDZ), indicating that lactation may be associated with an increased activity state at the GABA/BDZ receptor complex similar to BDZ treatment. A logical prediction of this hypothesis is that BDZ antagonists should decrease typical maternal behaviours involved, such as aggression. We tested this hypothesis by measuring the behavioural effects of the BDZ antagonist RO 15-1788 (1.25-10 mg/kg IP) on aggressive behaviour of lactating female rats confronted with male intruders. We could not support the hypothesis; no consistent behavioural effects of RO 15-1788 on aggression were found. The implications of this finding for the proposed hypothesis are discussed.

Humoral defence factors in the breast milk of Ethiopian women with leprosy and healthy controls.

Secretory IgA, lactoferrin, albumin, and total protein were quantitated in colostrum and milk samples obtained from 215 Ethiopian nursing mothers over a period ranging from 1 day to 2 yr postparturition. IgG, IgM, C3, and C4 complement components were quantitated in 11 day 1 samples. The subjects were classified into three groups: lepromatous leprosy, borderline lepromatous leprosy, and a nonlepromatous group consisting of women with tuberculoid leprosy and healthy controls. Results obtained from the above groups were also compared with a group from Edinburgh. No major variation in levels of secretory IgA, lactoferrin, albumin, and total protein was found between the three groups of Ethiopian women. Results from the Edinburgh group were significantly higher, mainly in the level of total protein. When the individual proteins were expressed as a percentage of the total protein, there was no difference between the milk samples from the Ethiopian and Edinburgh mothers.

Leprosy complicating pregnancy and puerperium / ?

1- Twenty eight cases with 58 pregnancies during a period of 7 years.2- Leprosy has no adverse effect on fertility. 3- Leprosy either initiates, aggravates or exacerbates during pregnancy and puerperium irrespective of whether cases are under treatment or not. 4- There is possibility of transplacental transfer of acid fast bacilli as seen from their presence in placenta, cord and cord blood