RESUMO
Neuropathic arthropathy (Charcot's arthropathy) is a progressive articular disease associated with a reduced sensorial and protector proprioceptive reflex. Its etiology includes many different conditions such as syringomyelia, traumatic lesion causing medullary deformity, spina bifida, diabetic neuropathy, leprosy neuropathy, neurofibromatosis, amyloid neuropathy, alcohol, and repetitive injection of hydrocortisone into joints, among others. However, the relationship between Charcot's arthropathy and herpetic encephalitis has not yet been described. Herpes encephalitis causes acute and chronic diseases of the peripheral or central nervous system. It can manifest as subacute encephalitis, recurrent meningitis, or myelitis. It can also resemble psychiatric syndromes, diplopia, sensory changes in the face and limbs, personality changes, frontal dysexecutive syndrome, stiff neck, subclinical alterations of the vestibular function, intracranial hypertension, convulsion, hemiparesis, and generally includes motor components, among others. On the other hand, pure peripheral sensory disturbance has not been described. In this article, we report the clinical case of a patient with Charcot's arthropathy secondary to pure peripheral sensory polyneuropathy as a consequence of progressive herpetic encephalitis sequelae. In this article, the authors report the first case of Charcot's arthropathy secondary to herpetic encephalitis.
Assuntos
Artropatia Neurogênica/imunologia , Encefalite por Herpes Simples/complicações , Doenças do Sistema Nervoso Periférico/imunologia , Doenças do Sistema Nervoso Periférico/virologia , Vias Aferentes/imunologia , Vias Aferentes/patologia , Vias Aferentes/virologia , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/inervação , Articulação do Tornozelo/patologia , Artropatia Neurogênica/diagnóstico por imagem , Artropatia Neurogênica/patologia , Progressão da Doença , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/inervação , Articulação do Cotovelo/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Nervos Periféricos/diagnóstico por imagem , Nervos Periféricos/imunologia , Nervos Periféricos/patologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Radiografia , Células Receptoras Sensoriais/imunologia , Células Receptoras Sensoriais/patologia , Células Receptoras Sensoriais/virologiaRESUMO
Dermatomic analysis of the distribution of the hypopigmented patches of leprosy has revealed a pattern wherein patches are most frequent in dermatomes of the brachial plexus, decrease gradually in frequency in succeeding spinal segments and increase again in dermatomes of the lumbar plexus. The predilection of hypopigmented patches for certain dermatomes may be a reflection of easy vulnerability of the neural pigmentary mechanism and/or a reflection of selective multiplication of M. leprae in nerves of certain dermatomes, even though the organisms might have been seeded all over the body by hematogenous spread. These preliminary observations are discussed.