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1.
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.
An Bras Dermatol ; 94(5): 586-589, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31777361

RESUMEN

Cutaneous neoplasms frequently occur in leprosy, but there are few reports of the coexistence of leprosy and basal cell carcinoma in the same lesion. This case reports a 49-year-old male with an ulcerated plaque on the right lateral nasal wall, bright papules on the sternal region, and a blackened plaque on the right temporal region. The nasal and temporal lesions were diagnosed by histopathology as basal cell carcinoma and melanoma, respectively. The sternal lesions were excised with the repair of the "dog ear" which histopathological examination showed macrophages in the dermis parasitized with acid-fast bacilli, confirming the diagnosis of lepromatous leprosy with Fite-Faraco staining. This case report highlights the importance of referring the dog-ear specimen for histopathologic analysis.


Asunto(s)
Carcinoma Basocelular/complicaciones , Lepra Lepromatosa/complicaciones , Melanoma/complicaciones , Neoplasias Cutáneas/complicaciones , Biopsia , Carcinoma Basocelular/patología , Humanos , Lepra Lepromatosa/patología , Masculino , Melanoma/patología , Persona de Mediana Edad , Neoplasias Cutáneas/patología
4.
An. bras. dermatol ; 94(5): 586-589, Sept.-Oct. 2019. graf
Artículo en Inglés | LILACS | ID: biblio-1054853

RESUMEN

Abstract Cutaneous neoplasms frequently occur in leprosy, but there are few reports of the coexistence of leprosy and basal cell carcinoma in the same lesion. This case reports a 49-year-old male with an ulcerated plaque on the right lateral nasal wall, bright papules on the sternal region, and a blackened plaque on the right temporal region. The nasal and temporal lesions were diagnosed by histopathology as basal cell carcinoma and melanoma, respectively. The sternal lesions were excised with the repair of the "dog ear" which histopathological examination showed macrophages in the dermis parasitized with acid-fast bacilli, confirming the diagnosis of lepromatous leprosy with Fite-Faraco staining. This case report highlights the importance of referring the dog-ear specimen for histopathologic analysis.


Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Neoplasias Cutáneas/complicaciones , Carcinoma Basocelular/complicaciones , Lepra Lepromatosa/complicaciones , Melanoma/complicaciones , Neoplasias Cutáneas/patología , Biopsia , Carcinoma Basocelular/patología , Lepra Lepromatosa/patología , Melanoma/patología
5.
Biomedica ; 39(Supl. 2): 26-31, 2019 08 01.
Artículo en Inglés, Español | MEDLINE | ID: mdl-31529831

RESUMEN

Patients with lepromatous leprosy that have received treatment for many years usually get follow up biopsies for persistent skin lesions or positive bacilloscopy even if the values are lower than in the initial bacilloscopy. We report the case of a 48-year old woman with long-standing lepromatous leprosy of 15 years of evolution, with a bacterial index of 4 in the direct smear and the initial skin biopsy. The patient was treated with multidrug therapy for 32 months although the treatment recommended by the World Health Organization (WHO) is only for 12 months. A skin biopsy was taken to determine if there was an active disease. We observed a diffuse dermal inflammation with numerous foreign body giant cells and vacuolated macrophages (Virchow´s cells). These cells contained granular acid-fast material that was also positive with immunohistochemistry for BCG. There were fragmented bacilli and the BI was 2. These cells were also strongly positive for CD68. The biopsy was interpreted as a residual form of lepromatous leprosy that did not require further multidrug therapy. We have observed similar histological profiles in several cases. The lack of clinical data makes it a histological challenge. The accumulation of lipids in these giant cells is due to bacillary destruction and fusion of vacuolated macrophages. We discuss here the role of bacillary and host lipids in the pathogenesis of lepromatous leprosy. We concluded that there was no need to extend the 12-month multidrug therapy recommended by WHO.


Asunto(s)
Células Espumosas/patología , Células Gigantes de Cuerpo Extraño/patología , Lepra Lepromatosa/patología , Piel/patología , Antígenos CD/análisis , Antígenos de Diferenciación Mielomonocítica/análisis , Biopsia , Pared Celular/química , Quimioterapia Combinada , Femenino , Células Espumosas/química , Células Espumosas/microbiología , Células Gigantes de Cuerpo Extraño/química , Células Gigantes de Cuerpo Extraño/microbiología , Interacciones Huésped-Patógeno , Humanos , Leprostáticos/uso terapéutico , Lepra Lepromatosa/tratamiento farmacológico , Lípidos/análisis , Persona de Mediana Edad , Mycobacterium leprae/química , Mycobacterium leprae/aislamiento & purificación , Piel/microbiología , Vacuolas
8.
J Eur Acad Dermatol Venereol ; 33(10): 1947-1951, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31004456

RESUMEN

BACKGROUND: Leprosy, a chronic granulomatous infection has varied clinical presentations spanning across different spectrums. The scope of dermatoscopy is vast and has been studied for other granulomatous disorders like sarcoidosis. OBJECTIVES: The objective of this study was to describe the dermatoscopic features of the entire spectrum of leprosy and to correlate with clinical and histopathological findings. METHODS: This was a prospective observational study of treatment naïve leprosy patients over a period of 1 year. The study patients were categorized as per Ridley-Jopling classification based on clinical, slit skin smear and histopathological findings. Most representative lesions were photographed, evaluated by dermatoscopy and were biopsied. RESULTS: A total of 30 patients (21 males and 9 females) were recruited; 2 cases of tuberculoid leprosy, 12 cases of borderline tuberculoid (3 with type 1 reaction), 8 cases of borderline lepromatous, 6 cases of lepromatous leprosy (3 with type 2 reaction) and 2 cases of Histoid leprosy. The dermatoscopic featues consistently seen were yellowish orange areas and vascular structures like linear branching vessels and crown vessels correlating with the presence of dermal granulomas and dilated vessels. Broken pigment network, white chrysalis like areas were seen in addition. Tuberculoid spectrum also had absence of or diminished hair follicles and eccrine duct openings correlating with presence of peri-appendageal granuloma and appendageal destruction. Scaling and follicular plugs were other features in lesions of type 1 reaction. CONCLUSION: Yellowish-orange areas and vascular structures are the common dermatoscopic features of leprosy. Broken pigment network and paucity of appendageal structures are additional specific features.


Asunto(s)
Dermoscopía , Lepra/diagnóstico por imagen , Lepra/patología , Adulto , Biopsia , Femenino , Humanos , Lepra Lepromatosa/diagnóstico por imagen , Lepra Lepromatosa/patología , Lepra Tuberculoide/diagnóstico por imagen , Lepra Tuberculoide/patología , Masculino , Fotograbar , Estudios Prospectivos
12.
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
13.
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
14.
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
15.
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
16.
Am J Trop Med Hyg ; 100(2): 377-385, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30652669

RESUMEN

Type 2 reaction (T2R) or erythema nodosum leprosum (ENL), a sudden episode of acute inflammation predominantly affecting lepromatous leprosy patients (LL), characterized by a reduced cellular immune response. This possibly indicates a close relationship between the onset of T2R and the altered frequency, and functional activity of T lymphocytes, particularly of memory subsets. This study performed ex vivo and in vitro characterizations of T cell blood subpopulations from LL patients with or without T2R. In addition, the evaluation of activity of these subpopulations was performed by analyzing the frequency of these cells producing IFN-γ, TNF, and IL-10 by flow cytometry. Furthermore, the expression of transcription factors, for the differentiation of T cells, were analyzed by quantitative real-time polymerase chain reaction. Our results showed an increased frequency of CD8+/TNF+ effector memory T cells (TEM) among T2Rs. Moreover, there was evidence of a reduced frequency of CD4 and CD8+ IFN-γ-producing cells in T2R, and a reduced expression of STAT4 and TBX21. Finally, a significant and positive correlation between bacteriological index (BI) of T2R patients and CD4+/TNF+ and CD4+/IFN-γ+ T cells was observed. Thus, negative correlation between BI and the frequency of CD4+/IL-10+ T cells was noted. These results suggest that CD8+/TNF+ TEM are primarily responsible for the transient alteration in the immune response to Mycobacterium leprae in ENL patients. Thus, our study improves our understanding of pathogenic mechanisms and might suggest new therapeutic approaches for leprosy.


Asunto(s)
Linfocitos T CD4-Positivos/inmunología , Linfocitos T CD8-positivos/inmunología , Eritema Nudoso/inmunología , Lepra Lepromatosa/inmunología , Mycobacterium leprae/patogenicidad , Factor de Necrosis Tumoral alfa/inmunología , Adolescente , Adulto , Anciano , Linfocitos T CD4-Positivos/microbiología , Linfocitos T CD8-positivos/microbiología , Estudios de Casos y Controles , Eritema Nudoso/genética , Eritema Nudoso/patología , Femenino , Regulación de la Expresión Génica , Interacciones Huésped-Patógeno/genética , Interacciones Huésped-Patógeno/inmunología , Humanos , Memoria Inmunológica , Inmunofenotipificación , Interferón gamma/genética , Interferón gamma/inmunología , Interleucina-10/genética , Interleucina-10/inmunología , Lepra Lepromatosa/genética , Lepra Lepromatosa/patología , Masculino , Persona de Mediana Edad , Mycobacterium leprae/crecimiento & desarrollo , Mycobacterium leprae/inmunología , Cultivo Primario de Células , Factor de Transcripción STAT4/genética , Factor de Transcripción STAT4/inmunología , Transducción de Señal , Proteínas de Dominio T Box/genética , Proteínas de Dominio T Box/inmunología , Factor de Necrosis Tumoral alfa/genética
20.
Fontilles, Rev. leprol ; 31(6): 443-466, sept.-dic. 2018. ilus, tab
Artículo en Español | IBECS | ID: ibc-178459

RESUMEN

Objetivos: 1. Evaluar la immunohistoquimica de los granulomas de la lepra en las muestras de biopsias cutáneas de pacientes con lepra tuberculoide y lepromatosa, con respecto a la presencia y distribución de células T CD4+, CD8+ y CD28+, células CD 68+ y células CD1a+. 2. Evaluar los hallazgos inmunohistoquimicos observados en leprorreacciones. Metodología: Estudio descriptivo. Se seleccionaron para el estudio biopsias cutaneas, en las que se había diagnosticado clínica e histopatologicamente lepra entre el 1.8.2016 al 31.5.2017 en el Instituto Medico Gubernamental, Kozhikode. Se estudió la immunohistoquimica de las lesiones cutáneas en lepra y leprorreacciones, observando específicamente la distribución de células CD4/ CD8/ CD28/ CD68/ CD1a en la lepra en distintos escenarios. Resultados: En el estudio se incluyeron veintiséis casos tuberculoides y 14 lepromatosos. Todos los granulomas independientemente del tipo de enfermedad presentaron tinción positiva por CD4 y CD68. Dos de los 14 casos lepromatosos (14・3%), y 15/26 (57・7%) de las muestras tuberculoides presentaron expresion CD4 de moderada a fuerte. Se detectó negatividad CD28 en cuatro casos tuberculoides (15・4%) y en 10 lepromatosos (71・4%). La expresion CD4 moderada a fuerte se detectó en más del 70% de los T1R incremento mientras que en los demás grupos solo fue de 20%-50%. Más del 80% de las T1R estáticas e incremento presentaban positividad CD28, mayor de que el 30%-50% registrado en otros grupos. Conclusiones: Los resultados revelan que la inmunohistoquimica tiene un papel en aclarar los complejos procesos inmunológicos empleados en la lepra y las leprorreacciones


Objectives: 1. To study the immunohistochemistry of leprosy granulomas in the skin biopsy specimens of patients with tuberculoid and lepromatous leprosy, with respect to the presence and arrangement of CD4+, CD8+ and CD28+ T cells, CD 68+ cells and CD1a+ cells. 2. To study the immunohistochemistry findings observed in leprosy reactions. Design: Descriptive study. Skin biopsies in which the clinical and histopathological diagnosis of leprosy was reported between 1.8.2016 to 31.5.2017 in the Government Medical College, Kozhikode, were selected for the study. Immunohistochemistry of the skin lesions in leprosy and leprosy reactions was studied, looking specifically for the distribution of CD4/ CD8/ CD28/ CD68/ CD1a positive cells in leprosy at different scenarios. Results: Twenty-six tuberculoid and 14 lepromatous cases were included in the study. All granulomas irrespective of disease type showed positive staining for CD4 and CD68. Two of the 14 lepromatous leprosy cases (14・3%), and 15/26 (57・7%) tuberculoid specimens manifested moderate to strong CD4 expression. CD28 negativity was documented in four tuberculoid (15・4%) and 10 lepromatous cases (71・4%). Moderate to strong CD4 expression was noted in more than 70% of upgrading T1R while a similar finding was documented in only 20%-50% of other groups. More than 80% of static and upgrading T1R showed CD28 positivity, which was higher than the 30%-50% positivity recorded in other groups. Conclusions: The observations of the current study indicate a role for immunohistochemistry analysis in delineating the complex immunological processes involved in leprosy and leprosy reactions


Asunto(s)
Humanos , Inmunohistoquímica , Granuloma/diagnóstico , Lepra Lepromatosa/diagnóstico , Lepra Tuberculoide/diagnóstico , Biopsia , Granuloma/patología , Lepra Lepromatosa/patología , Lepra Tuberculoide/patología , Epidermis/citología , Epidermis/patología , Antígenos CD28/análisis , Antígenos CD1/análisis , Antígenos CD4/análisis , Antígenos CD8/análisis
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