Long-term ulcerations caused by Mycobacterium lepromatosis.

Patients with leprosy rarely present ulcerated lesions that can appear during reactional states like Lucio's phenomenon (LP), as in our case. LP is a rare complication of multibacillary leprosy due to massive bacilli invasion of endothelial cells causing a thrombotic syndrome. The initial macular lesion is purpuric followed by multiple infiltrated papules and nodules, some of them ulcerated, associated to loss of sensation on lower limbs. The importance of recognizing ulcers as a specific cutaneous manifestation of leprosy allows early diagnosis and treatment, and therefore avoiding the development of disabilities and persistence of illness. Infection by Mycobacterium lepromatosis is associated with LP and it should be especially sought in patients from endemic areas.

Diagnostic delay in a patient with reactional lepromatous leprosy treated as testicular tuberculosis.

Leprosy is a chronic neglected and stigmatizing disease. Due to involvement of the peripheral nerves, it can result in physical disabilities, deformities, and emotional damage if not diagnosed and treated promptly. This is the case of a young patient with testicular pain and swelling and no improvement after a specific therapeutic scheme for tuberculosis. Clinical and laboratory reevaluation revealed hypoesthetic skin patches associated with post-burn crusted ulcers on the left arm, thickening of ulnar nerves, atrophy of interosseous muscles of the hands, positive skin smear microscopy, and testicular histopathology with numerous bacilli forming globi. These findings indicated lepromatous leprosy with type II reaction.

Diagnostic delay in a patient with reactional lepromatous leprosy treated as testicular tuberculosis

Abstract Leprosy is a chronic neglected and stigmatizing disease. Due to involvement of the peripheral nerves, it can result in physical disabilities, deformities, and emotional damage if not diagnosed and treated promptly. This is the case of a young patient with testicular pain and swelling and no improvement after a specific therapeutic scheme for tuberculosis. Clinical and laboratory reevaluation revealed hypoesthetic skin patches associated with post-burn crusted ulcers on the left arm, thickening of ulnar nerves, atrophy of interosseous muscles of the hands, positive skin smear microscopy, and testicular histopathology with numerous bacilli forming globi. These findings indicated lepromatous leprosy with type II reaction.

Cutaneous myiasis of scalp in a young girl related to Musca domestica.

Cutaneous myiasis is a parasitic disease secondary to the presence of the larvae of certain insects, particularly diptera, in the skin of man or vertebrates [1]. Human myiasis is a rare clinical condition, but more frequently seen in tropical and subtropical areas. Hot humid climate with inadequate sanitary conditions favor the development of this condition. Dermatitis, psychiatric illnesses, leprosy, and diabetes are some contributory factors [2]. Treatment of myiasis, once diagnosed, is simple and rapid recovery is anticipated.

Acute genital ulcers.

Acute genital ulcers, also known as acute vulvar ulcers, ulcus vulvae acutum or Lipschütz ulcers, refer to an ulceration of the vulva or lower vagina of non-venereal origin that usually presents in young women, predominantly virgins. Although its incidence is unknown, it seems a rare entity, with few cases reported in the literature. Their aetiology and pathogenesis are still unknown. The disease is characterised by an acute onset of flu-like symptoms with single or multiple painful ulcers on the vulva. Diagnosis is mainly clinical, after exclusion of other causes of vulvar ulcers. The treatment is mainly symptomatic, with spontaneous resolution in 2 weeks and without recurrences in most cases. We present a case report of a 13-year-old girl with two episodes of acute ulcers that fit the clinical criteria for Lipschütz ulcers.

Mononeuritis multiplex and painful ulcers as the initial manifestation of hepatitis B infection.

Hepatitis B virus infection leads to multisystem manifestations owing to involvement of kidney, skin, vasculature, haematopoietic and nervous system. The hepatitis B infection can cause neuropathy either to vasculitis associated with polyarteritis nodosa or immune-mediated neural damage. In this submission, we report a young woman, who presented with mononeuritis multiplex and painful ulcerations as the first manifestation of chronic hepatitis B virus infection. The antiviral therapy along with steroids led to remarkable recovery. The clinical settings of hepatitis B virus infection should not be ignored in the presentation of mononeuritis multiplex with ulcers, although the commonest cause is leprosy in the Indian sub-continent.

Vulvar ulcer as a presentation of systemic Langerhans cell histiocytosis.

We report a 38-year-old housewife with systemic Langerhans cell histiocytosis (LCH) presenting as a chronic vulvar and peri-anal ulcer. She had systemic involvement in the form of diabetes insipidus and bone "hot-spots". She responded favorably to etoposide, 6-mercaptopurine, and systemic steroids, and has been in remission since 10 years. Chronic vulvar ulcers not responding to routine therapy should not be neglected and need to be biopsied repeatedly to come to a specific diagnosis. The vulvar ulcer in our case provided a vital clue to a systemic LCH, with a successful outcome.

[Buruli ulcer (Mycobacterium ulcerans infection); report from the International Congress in Yamoussoukro, Ivory Coast]. / Buruli-ulcus (infectie met Mycobacterium ulcerans); verslag van een internationaal congres in Yamoussoukro, Ivoorkust.

Mycobacterium ulcerans infection (Buruli ulcer) is the third important mycobacterial disease world-wide in immunocompetent humans, after tuberculosis and leprosy. M. ulcerans is an environmental mycobacterium which has now been recovered from water and soil in swampy areas, and transmission to man occurs presumably through minor skin traumas. Endemic foci are known throughout the world, predominantly in tropical rain forest areas. The clinical presentation varies between a papule, a nodule or an ulceration with typically undermined edges. Surgery is the only effective treatment. BCG vaccination has a moderate protective effect. An association with HIV infection has not been demonstrated so far. Poor communities, with limited access to health care, and especially children are affected. The medical and socioeconomic burden imposed by the disease is tremendous. During the last decade the incidence of the disease has increased dramatically, particularly in West Africa. Possibly this is connected with changes in the natural ecosystem. The Yamoussoukro declaration on Buruli ulcer, adopted July 6, 1998, is the basis of improvement of awareness, health education, treatment, and research on M. ulcerans infection. Support by the international community is urgently needed.

El mal perforante dorsal en la lepra. Su tratamiento

Se presentan 31 casos de males perforantes dorsales (28 de pies y 3 de manos), con una frecuencia del 24 por cento del total de males perforantes, se dan explicaciones de la patogenia en las que interviene el roce con el calzado de la articulaciones y se exponen los tratamientos quirúrgicos que son los que mejor resultado han dado.

The use of hydergine in the treatment of trophic ulcers in leprosy

A controlled study was made on a small series of 19 patients with 26 ulcerated feet between them. Ten patients (with 14 ulcerated feet) were given 0.25 mgm. Hydergine thrice daily in the form of sublingual tablets, and 9 patients (12feet) were controls and were given a placebo. The results showed that there was no substantial difference in the progress of the ulcers in the two groups.

Treatment of trophic ulcers of leprosy with roniacol

1- A double-blind study of the use of Roniacol, a vasodilator, with respect to its effect on the healing time of plantar trophic ulcers, was made in four cases. 2- The drug is a harmless adjunct to other methods of therapy. 3- In some cases there may be benefit from its use, either subjectively or objectively, if collateral conditions of excessive fibrosis do not interfere with augmented circulation.

A proposito do tratamento das ulceras de leprosos pelas infiltrações intradermicas

O autor prosegue nas suas observações sobre o tratamento de ulceras e das suas manifestações dolorosas. Applicou infiltrações intradermicas de estheres de chaulmoogra, ao redor das ulceras. Descreve o estado em que as encontrou, 2 1/2 mezes após a publicação do seu primeiro trabalho e conclue, mais uma vez, que esse tratamento não só favorece a cicatrização, como melhora ou suprime as dores.