Reação Reversa Hansênica como manifestação de reconstituição imune após tratamento quimioterápico em paciente com Carcinoma Ductal Invasivo de Mama / Reverse reaction leprosy as a manifestation of immune reconstitution after chemotherapy in patients with Invasive Ductal Breast Cancer

INTRODUÇÃO: A Hanseníase é uma dermatose infectocontagiosa crônica, causada pelo Mycobacterium leprae, caracterizada por apresentar formas clínicas contrastantes, que são dependentes da interação do bacilo com a resposta imune do hospedeiro. Apesar de curável, ela ainda é um problema de saúde pública relevante, pois persiste como endemia em muitos países, dentre eles o Brasil. DESCRIÇÃO DO CASO: Paciente, 58 anos, após tratamento quimioterápico para Carcinoma Ductal Invasivo da Mama, desenvolveu manchas com perda de sensibilidade que após exame clinico e anatomopatológico evidenciou se tratar de uma Reação Reversa Hansênica. DISCUSSÃO: O diagnóstico precoce da hanseníase permanece um importante desafio de saúde pública, principalmente devido à heterogeneidade das suas manifestações clínicas. No caso apresentado, a recuperação imunológica, após tratamento quimioterápico desencadeou a reação reversa hansênica, permitindo o reconhecimento da doença e a sua confirmação diagnóstica. CONCLUSÃO: O diagnóstico precoce da Hanseníase requer o conhecimento não apenas das suas formas clínicas, como também de seus episódios reacionais, já que são durante esses episódios, que ocorre piora das lesões neurológicas e aumento das incapacidades físicas. (AU)

Introduction: Leprosy is a chronic infectious contagious dermatosis caused by Mycobacterium leprae, characterized by presenting contrasting clinical forms, which are dependent on the interaction of the bacillus with a host immune response. Although curable, it is still a relevant public health problem, as it persists as an endemic disease in many countries, including Brazil. Case Description: Patient, 58 years old, after chemotherapy treatment for Invasive Ductal Breast Carcinoma of the Mama, developed spots with loss of sensitivity by clinical and anatomopathological examination evidenced whether it is a Reverse Hansen Reaction. Discussion: The prior diagnosis of leprosy remains an important public health challenge, mainly due to the heterogeneity of its clinical manifestations. In the case, an immunological recovery, a chemotherapeutic treatment triggered the leprosy reverse reaction, allowing the recognition of the disease and its diagnostic confirmation. Conclusion: The previous diagnosis of the applicant leprosy is not only in its clinical forms, but also in its reactional episodes, since it is during these episodes that worsening of the neurological lesions and increase of the physical incapacities occur. (AU)

Erythematous nodules of the hand: a rare site of metastatic breast carcinoma.

Acral cutaneous metastasis is a rare phenomenon. A 38-year-old woman presented with painful lesions in the left hand since 1 month. On examination, multiple painful, erythematous, lobulated plaques and nodules were present over the palmar aspect of the finger tips and thenar eminence. Biopsy of the nodule revealed lobules of small pleomorphic epithelial cells arranged in singles, small nests, cords and small abortive luminal pattern in an abundant mucoid matrix, suggestive of metastatic mucinous carcinoma. Past history revealed that the patient had undergone bilateral mastectomy for carcinoma breast. Diagnosis of cutaneous metastases is based on clinical history and histopathological examination. Identification of the primary tumor is very important for prompt treatment and prognosis. The rarity of pure acral cutaneous metastasis and its possible pathogenetic mechanisms are discussed.