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2.
Fontilles, Rev. leprol ; 32(3): 155-161, sept.-dic. 2019. ilus
Artículo en Español | IBECS | ID: ibc-189962

RESUMEN

El fenómeno de Lucio es una reacción inmunológica que ocurre en la lepra de Lucio y se caracteriza por placas ulceradas y necróticas en las extremidades. Es común en pacientes que no recibieron tratamiento o en aquellos que lo recibieron de manera inadecuada y se manifiesta clínicamente como maculas purpuricas que progresan a lesiones ulcerosas superficiales, poligonales o anguladas con sensación quemante en un paciente sin fiebre, ni síntomas generales, ni daño visceral. El cuadro no dura más de 15 días. Presentamos un paciente masculino de 67 años de edad con antecedentes familiares de Hansen (convivente intradomiciliario de primer orden) valorado en Hospital municipal de Florida por presentar manchas de color oscuro en brazos y piernas solicitando interconsulta con la especialidad de Dermatología diagnosticándose una lepra lepromatosa con fenómeno de Lucio


The Lucio phenomenon is an immunological reaction characterized by ulcerated plaques and necrotic ulcers in the extremities. It is more common in patients that have not received treatment before or in those that received it in an inadequate way and it is manifested clinically as purpuric patches that progress to superficial, polygonal or angled ulcerous lesions with burning sensation in a patient without fever, general symptoms or visceral damage. The clinical picture does not last more than 15 days. We present a male patient 67 years old with antecedents of Hansen (intra domiciliary contact) examined in a local hospital in Florida presenting dark patches (spots) on arms and legs and diagnosed of Lucio`s phenomenon type of lepromatous leprosy


Asunto(s)
Humanos , Masculino , Anciano , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/patología , Necrosis
3.
Fontilles, Rev. leprol ; 32(3): 169-174, sept.-dic. 2019. ilus
Artículo en Español | IBECS | ID: ibc-189964

RESUMEN

La lepra se considera uno de los padecimientos más antiguos de la humanidad. Se ha dicho no sin razón que la lepra es una afección del cuerpo del paciente y de la mente de las demás personas. Se trata de un paciente blanco, masculino, 44 años de edad que acude con lesiones no pruriginosas en piel en forma de ronchas de varios meses de evolución que en su área de salud ha sido tratado y estudiado como una urticaria crónica. A pesar del tratamiento continua con las lesiones que se han exacerbado en las últimas dos semanas. Niega fiebre, decaimiento u otra sintomatología. Al examen dermatológico se constata cuadro cutáneo diseminado, caracterizado por placas infiltradas de aspecto urticariforme de tamaño entre 1 y 5 cm, número variable que asentaban en tronco, región interescapular y porciones proximales de los miembros, con zonas de hipoestesia intra y perilesional, se palpan nervios cubitales engrosados, no dolorosos, de forma simétrica y bilateral. Es de particular importancia el conocimiento de esta enfermedad para los médicos porque las diferentes respuestas del huésped plantean un problema diagnóstico desafiante, lo cual provoca innegables dificultades en su detección debido a su diversidad de expresiones clínicas y su baja prevalencia, que contribuye a que especialistas poco entrenados puedan hacer diagnósticos erróneos, pues no piensan en la lepra como un posible diagnóstico


Leprosy is considered one of the oldest diseases suffered by humanity. It has been said not without reason that leprosy is a condition of the patient’s body and the mind and thoughts of other people. This is a report of a 44-yearold white, male patient who attended the clinic with non-pruritic skin lesions in the form of hives of several months of evolution that in his health area has been treated and studied as a chronic urticaria. Despite ongoing treatment during the last two weeks, the lesions continued exacerbated. The patient refers no fever, fatigue or other symptoms. The dermatological examination revealed disseminated cutaneous symptoms, characterized by infiltrated urticariform plaques between 1 and 5 cm in size and located on the trunk, interscapular region and proximal portions of the limbs, with areas of intra and perilesional hypoaesthesia, palpated thickened symmetrically and bilaterally but not painful ulnar nerves. Of particular importance is the knowledge needed by the doctor concerning this disease because the different responses of the host pose a challenging diagnostic problem. There are also diagnostic difficulties due to its clinical spectrum and low prevalence. Medical personnel poorly trained in leprosy can make wrong diagnostic decisions


Asunto(s)
Humanos , Masculino , Adulto , Lepra Lepromatosa/diagnóstico , Urticaria/diagnóstico , Diagnóstico Diferencial
5.
J Med Case Rep ; 13(1): 276, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31472695

RESUMEN

BACKGROUND: Leprosy is a disease that was declared eliminated in 2010 from Nepal; however, new cases are diagnosed every year. The difficulty arises when the presentation of the patient is unusual. CASE PRESENTATION: In this case report we present a case of a 22-year-old Tamang man, from the Terai region of Nepal, with a clinical presentation of fever, malaise, and arthralgia for the past 2 weeks with hepatosplenomegaly and bilateral cervical, axillary, and inguinal lymphadenopathy. Features of chronic inflammation with elevated erythrocyte sedimentation rate of 90 mm/hour and liver enzymes were noted. With no specific investigative findings, a diagnosis of Still's disease was made and he was given prednisolone. On tapering the medication, after 2 weeks, the lymphadenopathy and fever reappeared. On biopsy of a lymph node, diagnosis of possible tuberculosis was made. On that basis anti-tuberculosis treatment category I was started. During his hospital stay, our patient developed nodular skin rashes on his shoulder, back, and face. The biopsy of a skin lesion showed erythema nodosum leprosum and he was diagnosed as having lepromatous leprosy with erythema nodosum leprosum; he was treated with anti-leprosy medication. CONCLUSION: An unusual presentations of leprosy may delay its prompt diagnosis and treatment; thus, increasing morbidity and mortality. Although leprosy has been declared eliminated, it should not be forgotten and physicians should have it in mind to make it a differential diagnosis whenever relevant.


Asunto(s)
Eritema Nudoso/diagnóstico , Lepra Lepromatosa/diagnóstico , Diagnóstico Tardío , Errores Diagnósticos , Humanos , Masculino , Nepal , Enfermedad de Still del Adulto/diagnóstico , Tuberculosis Ganglionar/diagnóstico , Adulto Joven
7.
BMJ Case Rep ; 12(6)2019 Jun 29.
Artículo en Inglés | MEDLINE | ID: mdl-31256049

RESUMEN

Leprosy is a chronic infectious, granulomatous disease caused by the intracellular bacillus Mycobacterium leprae that infects macrophages and Schwann cells. While relatively rare in the USA, there is about 200 new cases of leprosy every year with the majority occurring in the southern parts of the country. It is believed to be linked to the region of the nine-banned armadillo in patients with no significant travel history outside of the country. In this case report, we encountered a 58-year-old Central Florida man that had extensive exposure to armadillos and presented with the typical symptoms of large erythaematous patches, numbness and peripheral nerve hypertrophy. Once diagnosed properly, patients are then reported to the National Hansen's Centre who provides the multidrug therapy for 12-24 months. Due to its rarity and its ability to mimic other more common ailments, leprosy should be included in the differential diagnosis in patients that have significant exposure to armadillos, live in the southern part of the country or have recently travelled to countries that have a high prevalence of leprosy.


Asunto(s)
Armadillos/microbiología , Lepra Lepromatosa/diagnóstico , Mycobacterium leprae/aislamiento & purificación , Animales , Diagnóstico Diferencial , Florida , Humanos , Leprostáticos/uso terapéutico , Lepra Lepromatosa/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Rifampin/uso terapéutico
8.
Int J Mycobacteriol ; 8(2): 208-210, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31210170

RESUMEN

Hansen's disease is a chronic infectious granulomatous disease with varied clinical presentation. Histoid Hansen's disease is an important emerging lepromatous subset of Hansen's disease known to mimic varied dermatoses. Occurrence of reactions, especially erythema nodosum leprosum (ENL), is rare in this form of leprosy. We report a case of Histoid Hansen's disease with initial presentation of ENL while undergoing management for infertility.


Asunto(s)
Eritema Nudoso/diagnóstico , Eritema Nudoso/microbiología , Lepra Lepromatosa/microbiología , Lepra Multibacilar/diagnóstico , Adulto , Humanos , Leprostáticos/uso terapéutico , Lepra Lepromatosa/diagnóstico , Masculino , Piel/microbiología , Piel/patología
9.
An Bras Dermatol ; 94(2): 236-238, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31090835

RESUMEN

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.


Asunto(s)
Diagnóstico Tardío , Lepra Lepromatosa/diagnóstico , Enfermedades Testiculares/tratamiento farmacológico , Tuberculosis de los Genitales Masculinos/tratamiento farmacológico , Úlcera/diagnóstico , Adulto , Brazo , Humanos , Lepra Lepromatosa/complicaciones , Masculino , Orquitis/complicaciones , Orquitis/diagnóstico , Enfermedades Testiculares/patología , Tiempo de Tratamiento , Úlcera/complicaciones
10.
An. bras. dermatol ; 94(2): 236-238, Mar.-Apr. 2019. graf
Artículo en Inglés | LILACS | ID: biblio-1001142

RESUMEN

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.


Asunto(s)
Humanos , Masculino , Adulto , Enfermedades Testiculares/tratamiento farmacológico , Tuberculosis de los Genitales Masculinos/tratamiento farmacológico , Úlcera/diagnóstico , Lepra Lepromatosa/diagnóstico , Diagnóstico Tardío , Orquitis/complicaciones , Orquitis/diagnóstico , Brazo , Enfermedades Testiculares/patología , Úlcera/complicaciones , Lepra Lepromatosa/complicaciones
13.
Int J Mycobacteriol ; 8(1): 29-34, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30860176

RESUMEN

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.


Asunto(s)
Eritema Nudoso/diagnóstico , Eritema Nudoso/patología , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/patología , Úlcera/etiología , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , India , Masculino , Persona de Mediana Edad , Necrosis/etiología , Necrosis/patología , Estudios Retrospectivos , Centros de Atención Terciaria , Úlcera/patología , Adulto Joven
14.
An Bras Dermatol ; 94(1): 89-92, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30726471

RESUMEN

Erythroderma consists of erythema and scaling involving most or all of the body surface. This generalized eruption may be idiopathic, drug-induced or secondary to cutaneous or systemic disease. A 71-year-old man is reported presenting generalized erythema and desquamation with deck-chair sign, nail dystrophy, and plantar ulcers associated with loss of local tactile sensitivity. Biopsies from three different sites demonstrated diffuse lymphocytic infiltrate with incipient granulomas. Fite-Faraco staining showed numerous isolated bacilli and globi. The skin smear was positive. Clinical and pathological diagnosis of borderline lepromatous leprosy was confirmed. This report demonstrates that chronic multibacillary leprosy can manifest as erythroderma and thus should be included in the differential diagnosis.


Asunto(s)
Dermatitis Exfoliativa/complicaciones , Lepra Dimorfa/etiología , Lepra Lepromatosa/etiología , Anciano , Biopsia , Dermatitis Exfoliativa/diagnóstico , Dermatitis Exfoliativa/patología , Diagnóstico Diferencial , Humanos , Lepra Dimorfa/diagnóstico , Lepra Dimorfa/patología , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/patología , Masculino
15.
QJM ; 112(6): 429-435, 2019 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-30778548

RESUMEN

BACKGROUND: Histoid leprosy is a subtype of leprosy with distinct clinical presentation and histologic features. It accounts for <4% of leprosy cases. The exact location of histoid leprosy along the immune spectrum and its relation to other subtypes is unclear. AIM: To evaluate the local immune phenomenon which define histoid leprosy. DESIGN: Parallel skin biopsies from histoid lesions and from unremarkable skin in patients with histoid leprosy were evaluated and the histologic findings compared. METHODS: Formalin fixed, paraffin embedded tissue sections from lesional and non-lesional biopsies were assessed for changes in epidermis and dermis; type and extent of infiltrate, presence or absence of pseudocapsule and associated reactions. Bacillary index was evaluated using Wade Fite stain for lepra bacilli. RESULTS: Amongst 208 leprosy cases, six cases of histoid leprosy were identified (2.88%). The cases showed presence of nodules, patches and plaques overlying clinically unremarkable skin. Fourteen skin biopsies were evaluated of which the lesional biopsies showed equal proportion of fusocellular, fusocellular epithelioid and fusocellular-vacuolated histology. A greater circumscription was noted in lesional biopsies; however the cellular content of the infiltrate was similar in lesional and non-lesional biopsies. A case of erythema nodosum leprosum in histoid leprosy was also seen. CONCLUSIONS: Ours is the first study comparing normal and lesional skin in histoid leprosy. Though the histoid lesions appear to have a derivation from lepromatous leprosy, the local histologic and clinical alterations may be a result of heightened local immunity or reactive local modifying factors.


Asunto(s)
Eritema Nudoso/diagnóstico , Eritema Nudoso/patología , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/patología , Adulto , Anciano , Femenino , Humanos , Inmunohistoquímica , India , Masculino , Persona de Mediana Edad , Piel/patología
17.
An. bras. dermatol ; 94(1): 89-92, Jan.-Feb. 2019. graf
Artículo en Inglés | LILACS | ID: biblio-983733

RESUMEN

Abstract: Erythroderma consists of erythema and scaling involving most or all of the body surface. This generalized eruption may be idiopathic, drug-induced or secondary to cutaneous or systemic disease. A 71-year-old man is reported presenting generalized erythema and desquamation with deck-chair sign, nail dystrophy, and plantar ulcers associated with loss of local tactile sensitivity. Biopsies from three different sites demonstrated diffuse lymphocytic infiltrate with incipient granulomas. Fite-Faraco staining showed numerous isolated bacilli and globi. The skin smear was positive. Clinical and pathological diagnosis of borderline lepromatous leprosy was confirmed. This report demonstrates that chronic multibacillary leprosy can manifest as erythroderma and thus should be included in the differential diagnosis.


Asunto(s)
Humanos , Masculino , Anciano , Lepra Dimorfa/etiología , Lepra Lepromatosa/etiología , Dermatitis Exfoliativa/complicaciones , Biopsia , Lepra Dimorfa/diagnóstico , Lepra Dimorfa/patología , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/patología , Dermatitis Exfoliativa/diagnóstico , Dermatitis Exfoliativa/patología , Diagnóstico Diferencial
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