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1.
An Bras Dermatol ; 97(2): 231-235, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34996656

RESUMO

Patients with lepromatous or borderline leprosy may present two types of vasculonecrotic reactions: Lucio's phenomenon (LP) and necrotic erythema nodosum leprosum (nENL). These are serious conditions, which mostly lead to life-threatening infectious and thrombotic complications. The authors report the case of a patient with leprosy recurrence associated with an atypical type II reaction with LP characteristics on histopathology.


Assuntos
Eritema Nodoso , Hanseníase Dimorfa , Hanseníase Virchowiana , Hanseníase Multibacilar , Hanseníase , Eritema Nodoso/patologia , Humanos , Hanseníase/complicações , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/patologia , Hanseníase Multibacilar/complicações , Necrose
4.
Trop Doct ; 51(4): 542-552, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33722150

RESUMO

Non-neuropathic ulcers in leprosy patients are infrequently seen, and atypical presentations are prone to misdiagnosis. We evaluated diagnosed cases of leprosy between January 2017 and January 2020 for the presence of cutaneous ulceration, Ridley-Jopling subtype of leprosy, reactions and histologic features of these ulcerations. Treatment was given as WHO recommended multi-bacillary multi-drug therapy. We found 17/386 leprosy patients with non-neuropathic ulcers. We describe three causes - spontaneous cutaneous ulceration in lepromatous leprosy (one nodular and one diffuse), lepra reactions (five patients with type 1; nine with type 2, further categorised into ulcerated Sweet syndrome-like who also had pseudoepitheliomatous hyperplasia, pustulo-necrotic and necrotic erythema nodosum leprosum) and Lucio phenomenon (one patient). Our series draws attention towards the different faces of non-neuropathic ulcers in leprosy, including some atypical and novel presentations.


Assuntos
Eritema Nodoso , Hanseníase Virchowiana , Hanseníase , Eritema Nodoso/diagnóstico , Eritema Nodoso/etiologia , Humanos , Hanseníase/complicações , Hanseníase/diagnóstico , Hanseníase/tratamento farmacológico , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/diagnóstico , Hanseníase Virchowiana/tratamento farmacológico , Necrose , Úlcera
9.
Microbiol Spectr ; 7(3)2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31172908

RESUMO

Mycobacterium tuberculosis is an ancient master of the art of causing human disease. One important weapon within its fully loaded arsenal is the type VII secretion system. M. tuberculosis has five of them: ESAT-6 secretion systems (ESX) 1 to 5. ESX-1 has long been recognized as a major cause of attenuation of the FDA-licensed vaccine Mycobacterium bovis BCG, but its importance in disease progression and transmission has recently been elucidated in more detail. This review summarizes the recent advances in (i) the understanding of the ESX-1 structure and components, (ii) our knowledge of ESX-1's role in hijacking macrophage function to set a path for infection and dissemination, and (iii) the development of interventions that utilize ESX-1 for diagnosis, drug interventions, host-directed therapies, and vaccines.


Assuntos
Antígenos de Bactérias/imunologia , Proteínas de Bactérias/imunologia , Mycobacterium tuberculosis/imunologia , Mycobacterium tuberculosis/metabolismo , Tuberculose/imunologia , Sistemas de Secreção Tipo VII/imunologia , Sistemas de Secreção Tipo VII/metabolismo , Vacina BCG/imunologia , Sistemas de Secreção Bacterianos/metabolismo , Quimiocinas , Interações Hospedeiro-Patógeno , Humanos , Macrófagos/imunologia , Mycobacterium tuberculosis/patogenicidade , Necrose , Fagossomos , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/prevenção & controle , Vacinas , Virulência
10.
Int J Mycobacteriol ; 8(1): 29-34, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30860176

RESUMO

Background: Erythema nodosum leprosum (ENL) classically presents with tender, coppery, evanescent nodules along with constitutional features and visceral involvement. However, uncommon morphological variants of ENL-like erythema nodosum necroticans, erythema multiforme (EM)-like ENL, Sweet's syndrome (SS)-like ENL, Lucio phenomenon, and reactive perforating type of ENL have also been described in the literature. The primary objective of this study was to describe the clinical features of the severe and uncommon morphological variants of ENL. Methods: This was an observational case series with retrospective review of records of all ENL patients with ulceronecrotic lesions admitted in the Department of Dermato-venereo-leprology of a tertiary health center of central India over a period of 2 years. Results: Eighteen patients were included, all of whom had ulceronecrotic lesions. Four out of them had EM like ENL, two had SS-like presentation, and one of them had annular bullous lesions over old infiltrated plaques of leprosy. Conclusions: Uncommon variants of ENL can be very commonly misdiagnosed in patients, especially in those who have not been previously diagnosed with leprosy. Hence, a high index of suspicion is required in such cases to avoid delay in the diagnosis and resulting morbidity.


Assuntos
Eritema Nodoso/diagnóstico , Eritema Nodoso/patologia , Hanseníase Virchowiana/diagnóstico , Hanseníase Virchowiana/patologia , Úlcera/etiologia , Adolescente , Adulto , Idoso , Criança , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Necrose/etiologia , Necrose/patologia , Estudos Retrospectivos , Centros de Atenção Terciária , Úlcera/patologia , Adulto Jovem
12.
Rev. chil. dermatol ; 35(4): 146-149, 2019. ilus
Artigo em Espanhol | LILACS | ID: biblio-1120285

RESUMO

Se presenta caso de paciente masculino de 67 años de edad, fototipo III, con antecedentes patológicos personales de lepra lepromatosa en tratamiento, que acude a consulta especializada de Dermatología en el Hospital Guillermo Fernández Baquero (La Habana, Cuba) por lesiones ulcerosas diseminadas. Se realizan complementarios y se concluye caso como fenómeno de Lucio. Resaltando la infrecuencia de este eritema necrosante y la severidad de los estados reactivos de la lepra pues son procesos distintos pero destructores de los tejidos, supuestamente dirigidos por el sistema inmunológico que aumentan en gran medida la morbimortalidad de esta enfermedad


A case of a 67 year old male patient, phototype III, with a personal pathological history of lepromatous leprosy in treatment is presented at a specialized dermatology clinic at Guillermo Fernández Vaquero hospital for disseminated ulcerative lesions. Complementary are performed and case is concluded as a phenomenon of Lucio. Highlighting the infrequency of this necrotizingerythema and the severity of the reactive states of leprosy are different but destructive processes of the tissues, supposedlydirected by the immune system that greatly increase the morbidity and mortality of this disease.


Assuntos
Humanos , Masculino , Idoso , Úlcera Cutânea/diagnóstico , Úlcera Cutânea/etiologia , Hanseníase Virchowiana/complicações , Úlcera Cutânea/patologia , Eritema , Necrose
13.
Travel Med Infect Dis ; 26: 32-36, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29501703

RESUMO

BACKGROUND: Skin infections are among the leading causes of diseases in travelers. Diagnosing pathogens could be difficult. METHOD: We applied molecular assays for the diagnostic of a large collection of skin biopsies and swabs from travelers with suspected skin infections. All samples were tested by qPCR for Coxiella burnetti, Bartonella sp., Rickettsia sp., Borrelia sp., Ehrlichia sp., Tropheryma whipplei, Francisella tularensis, Mycobacteria sp., Staphylococcus aureus, Streptococcus pyogenes, Leishmania spp., Ortho poxvirus and Para poxvirus and then screened for the presence of bacteria by PCR amplification and sequencing, targeting the 16S rRNA gene. RESULTS: From January 2009 to January 2017, 100 international travelers presenting with a suspected skin infection were enrolled. We detected 51 patients with an identified pathogen on skin samples. Travelers presenting with eschars were more likely to have a positive PCR sample (n = 44/76, 57.9%) compared to other patients (n = 7/24, 29.2%). Spotted fever group Rickettsia (n = 28) was the most frequently detected pathogens (19 R. africae, 6 R. conorii, 3 R. mongolitimonae); S. aureus were detected in 11 patients; S. pyogenes in 3; Leishmania sp.; M. leprae and B. henselae in 1 patient, respectively. CONCLUSION: By targeting the most commonly encountered causative agents of travel-related skin infections, our strategy provides a sensitive and rapid diagnostic method.


Assuntos
Reação em Cadeia da Polimerase/métodos , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/microbiologia , Doença Relacionada a Viagens , Adolescente , Adulto , Idoso , Criança , DNA Bacteriano , Diagnóstico Diferencial , Europa (Continente)/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/microbiologia , RNA Ribossômico 16S
15.
Indian J Dermatol Venereol Leprol ; 84(4): 515-517, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29067932

RESUMO

Lymphomatoid papulosis type E (LyP) is a recently described subtype of LyP characterized by an angioinvasive infiltrate of atypical lymphocytes expressing CD30. We present a case of type E LyP with extensive cutaneous necrosis in the histopathological evaluation which was misdiagnosed as an ulcerative form of bacterial skin infection. The remarkable cutaneous necrosis showed in our case might be related to the angiodestructive infiltrate that was present in this circumstance.


Assuntos
Papulose Linfomatoide/diagnóstico , Papulose Linfomatoide/tratamento farmacológico , Metilprednisolona/administração & dosagem , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/tratamento farmacológico , Idoso , Anti-Inflamatórios/administração & dosagem , Humanos , Masculino , Necrose
16.
G Ital Dermatol Venereol ; 152(6): 615-637, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28845953

RESUMO

Most emergencies in dermatology comprise a variety of entities with a usually benign course. However, vasculopathies and vasculitis are not common, but they could represent respectively 1.9% and 4.4% of these entities according to some studies of Emergency Dermatology Department. They become an important disease which has to be identified early to establish appropriate management and treatment. Some of them are well known, such as the leukocitoclastic vasculitis, Schölein-Henoch, panarteritis nodosa, antineutrophil cytoplasmic antibody associated vasculitis, giant cell arteritis, cryoglobulinemic vasculitis and antiphospholipid syndrome. More frequent vasculopathies are livedoid vasculopathy, pigmented purpuric dermatosis and calciphylaxis. Less common ones are caused by interferon and cholesterol crystal embolization. Others are very infrequent as Degos disease and Sneddon Syndrome. Among the more recently described ones there are deficiency of adenosine deaminase type 2 and crystalglobulinemia. The other group is composed of vasculopathies associated to microorganism as infective endocarditis, septic vasculopathy, aspergillosis, fusariosis, strongiloidosis, ecthyma gangrenosum, lucio phenomenon of leprosy and necrotic arachnidism. Finally, among these entities we can also find diseases associated with proinflammatory stages as disseminated intravascular coagulation, myeloproliferative disorders, intravascular lymphoma, metastasis intravascular. When we face cutaneous lesions characterized by reticulated violaceous lesions, palpable purpura or cutaneous necrosis, a careful clinico-pathological correlation as well as some laboratory or radiological tests are mandatory to further delineate a diagnosis and a proper first line empirical treatment.


Assuntos
Emergências , Dermatopatias Vasculares/fisiopatologia , Vasculite/fisiopatologia , Dermatologia , Humanos , Necrose , Dermatopatias/diagnóstico , Dermatopatias/fisiopatologia , Dermatopatias/terapia , Dermatopatias Vasculares/diagnóstico , Dermatopatias Vasculares/terapia , Vasculite/diagnóstico , Vasculite/terapia
17.
An. bras. dermatol ; 91(5,supl.1): 60-63, Sept.-Oct. 2016. tab, graf
Artigo em Inglês | LILACS | ID: biblio-837947

RESUMO

Abstract Lucio’s phenomenon is an uncommon reaction characterized by severe necrotizing cutaneous lesions that occurs in patients with Lucio’s leprosy and lepromatous leprosy. It is considered by some authors as a variant of type 2 or 3 reaction. Death can occur because of blood dyscrasia or sepsis. Precipitating factors include infections, drugs and pregnancy. We report a 31-year-old female patient exhibiting both clinical and histopathological features of lepromatous leprosy and Lucio’s phenomenon presenting favorable response to treatment. We complement our report with a literature review of the Brazilian cases of Lucio’s phenomenon published in Portuguese and English.


Assuntos
Humanos , Feminino , Adulto , Úlcera Cutânea/patologia , Hanseníase Virchowiana/patologia , Pele/patologia , Úlcera Cutânea/tratamento farmacológico , Biópsia , Índice de Gravidade de Doença , Brasil , Hanseníase Virchowiana/tratamento farmacológico , Resultado do Tratamento , Necrose
20.
Clin Rheumatol ; 35(5): 1397-401, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-24863848

RESUMO

The different clinical forms of leprosy are mainly related to the variety of immunological responses to the infection. Several forms of lepromatous leprosy are recognized, including macular, nodular, and diffuse. Lucio's phenomenon is a rare but distinctive skin eruption seen in patients with diffuse lepromatous leprosy. The diffuse lesions of Lucio's phenomenon have a predilection for the extremities, can include nodules, and heal with atrophic stellate scars; histologically, a necrotizing vasculitis accompanied by a nonspecific inflammatory reaction may be seen. Because of its rarity and similarity with some manifestations of the rheumatic disease and other causes of vasculitis, Lucio's phenomenon may not be easily recognized, especially in non-endemic countries, which leads to confusing diagnosis and loss of time for treatment. We report five patients with vasculitis caused by Lucio's phenomenon.


Assuntos
Hanseníase Virchowiana/complicações , Necrose/complicações , Pele/patologia , Vasculite/complicações , Idoso , Feminino , Humanos , Hanseníase Virchowiana/patologia , Masculino , Pessoa de Meia-Idade , Necrose/patologia , Vasculite/patologia
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