Association of class I and II HLA alleles and haplotypes with susceptibility to vitiligo: a study of patients with vitiligo from southeast Brazil.

BACKGROUND: The association of vitiligo with the HLA complex has been previously described in various populations worldwide. However, until now, no similar study has been conducted in Brazil. The aim of this study was to determine the association of HLA alleles with vitiligo in the population of southeast Brazil. METHODS: DNA samples from 116 patients with vitiligo and 243 healthy controls were obtained using the salting-out technique. HLA class I (A*, B*, C*) and class II (DRB1* and DQB1*) alleles were amplified by polymerase chain reaction with specific oligonucleotide sequences. RESULTS: The case-control study identified susceptibility associations with alleles HLA-A*02 (P = 0.0001, Pc = 0.0020, odds ratio [OR] = 2.68, 95% confidence interval [CI] = 1.69-4.26) and HLA-DRB1*07 (P = 0.0001, Pc = 0.0013, OR = 2.69, 95% CI = 1.66-4.34). The alleles HLA-A*32 (P = 0.0156, Pc = 0.3120, OR = 22.43, 95% CI = 1.12-449.46) and HLA-DQB1*06 (P = 0.0207, Pc = 0.1035, OR = 0.28, 95% CI = 0.10-0.81) were associated with both localized and generalized vitiligo. The haplotype analysis revealed that A*02-B*51-C*15-DRB1*07-DQB1*02 (P = 0.0113), A*02-B*15-C*07-DRB1*13-DQB1*06 (P = 0.0340), and A*29-B*44-C*16-DRB1*07-DQB1*02 (P = 0.0340) were associated with a predisposition to the disease. CONCLUSIONS: Our results show that HLA alleles and haplotypes may contribute to the pathogenesis of vitiligo in the Brazilian population.

Hanseníase tuberculóide apresentando-se como lesão em raquete de tênis: relato de um caso típico / Tuberculoid leprosy presenting as a racket lesion: report of a typical case

A hanseníase tuberculóide é caracterizada, em geral, por lesões únicas ou em pequeno número, sendo o comprometimento neural intenso e localizado. A lesão "em raquete de tênis" caracteriza de forma particular esse comprometimento, e se apresenta sob a forma de um ramo nervoso sensitivo cutâneo emergindo de uma placa tuberculóide. Relata-se o caso de paciente masculino, 61 anos, com diagnóstico de hanseníase tuberculóide, cuja lesão permaneceu ativa mesmo após o término de poliquimioterapia paucibacilar (PQT-PB). Ao exame dermatológico, foi observado espessamento do ramo superficial do nervo ulnar, emergindo da placa tuberculóide típica em dorso da mão direita, caracterizando a "lesão em raquete de tênis". A sorologia para anti-PGL-1 foi negativa, o exame histopatológico da lesão demonstrou hanseníase de padrão tuberculóide com baciloscopia negativa, e a reação de Mitsuda foi fortemente positiva, confirmando o diagnóstico de hanseníase tuberculóide ativa. Foi reiniciado o tratamento com PQT-PB, além de emprego de neurolépticos, com discreta regressão da lesão. Neste relato, ao ser apresentado um caso típico de lesão "em raquete de tênis", evidencia-se a evolução clássica dos casos de hanseníase em pacientes Mitsuda positivos, onde a PQT geralmente não modifica a história natural da doença.

Tuberculoid leprosy is characterized, usually, by single or few lesions which show intense and localized neural impairement. The "racket lesion", which is described as pathognomonic of tuberculoid leprosy, presents with a cutaneous nerve branch emerging from a tuberculoid plaque. It is reported a case of a 61 years old male, with diagnosis of tuberculoid leprosy, whose lesion remained active even after the end of PB multidrugtherapy (PB-MDT). At dermatologic examination, enlargement of the sensitive cutaneous branch of the ulnar nerve was observed, which emerged from a tuberculoid plaque on the dorsum of the right hand, characterizing a "racket lesion". Serology for anti-PGL-1 was negative, and the Mitsuda reaction was highly positive, confirming the diagnosis of tuberculoid leprosy. MDT-PB was reinitiated, with little improvement. In this report, we describe the typical evolution of leprosy in individuals with positive Mitsuda reaction, where the MDT does not change the natural history of the disease.