Aspectos clínicos y epidemiológicos en pacientes timorenses con enfermedad de Hansen / Clinical and epidemiological aspects in Timor patients with the Hansen disease

Se realizó un estudio observacional, descriptivo y transversal de 14 pacientes con lepra, diagnosticados y atendidos en la consulta de Dermatología del Hospital Nacional Guido Valadares, en Dili, Timor Oriental, de julio a diciembre del 2015, con vistas a caracterizarles y describir algunos aspectos clínicos y epidemiológicos de la enfermedad. En la serie se obtuvo una mayor frecuencia de pacientes en el grupo etario de 26 a 35 años y del sexo masculino, la forma clínica predominante fue la multibacilar y el tiempo de evolución de los síntomas hasta que fuera establecido el diagnóstico fue de menos de un año. Igualmente, en la mayoría existieron reacciones agudas, principalmente de tipo II o eritema nudoso leproso, y diferentes grados de discapacidad.

An observational, descriptive and cross-sectional study of 14 patients with leprosy, diagnosed and assisted in the Dermatology Service of Guido Valadares National Hospital, in Dili, Timor Lester was carried out from July to December, 2015, with the aim of characterizing them and to describe some clinical and epidemiological aspects of the disease. In the series a higher frequency of patient was obtained in the age group 26 to 35 years and of the male sex, the predominant clinical form was the multibacilar and the time of clinical course of the symptoms up to reaching the diagnosis was shorter than a year. Equally, in most of them acute reactions were presented, mainly of type II or from the erythema leprosy group, and different degrees of inability.

Gyrate Erythema like Manifestation - An Unusual Presentation of Borderline Lepromatous Hansen's Disease

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. Once considered a taboo, it is still misdiagnosed and underdiagnosed. Leprosy can present in innumerable diverse ways which can be confused with many treatable and non-treatable, infectious and noninfectious disorders. Though leprosy is eliminated from India in 2005, still many new cases are being reported day by day. Here we found a very rare manifestation of borderline lepromatous leprosy presented with erythematous figurate bands over trunk, proximal extremities and erythematous patches over palms and soles.

De-novo Ulceration - Rare Lazarine Leprosy - like Presentation of Borderline Lepromatous Hansen's Disease

Leprosy is caused by Mycobacterium leprae, which has a distinct predilection for cooler parts of the body. There are many forms of leprosy that range from the mildest indeterminate form to the most severe lepromatous type. The type of disease an individual develops depends on the host immune status; with tuberculoid type being seen in those with good immunity and lepromatous form in individuals with poor immunity to leprosy bacillus. Deep ulcers may occur in association with erythema nodosum leprosum, Lazarine leprosy and Lucio phenomenon. We report a male who presented with multiple acute onset foul smelling stellate ulcers over bilateral extremities. He was diagnosed as Borderline lepromatous leprosy (not in reaction) on the basis of histopathology. This type of presentation has not been reported till date.

A Case of Borderline Lepromatous Leprosy Masquerading as Chronic Eczema / 나학회지

Leprosy is a chronic granulomatous disease affecting the skin and peripheral nervous system. Because of its variable manifestations, leprosy can be misdiagnosed as syphilis, sarcoidosis, psoriasis and eczema. A 73 year-old man showed erythematous papules on his arms and legs. He had been erroneously treated as eczema before the correct clinicopathological diagnosis of borderline lepromatous leprosy was made. We report this case to suggest that dermatologists should pay careful attention while diagnosing new cases of leprosy.

A 29-Year-Old Male with Borderline Lepromatous Leprosy.

Leprosy (Hansen’s disease) is a chronic granulomatous infectious disease that primarily affects the peripheral nerves, skin, upper respiratory tract mucosa, eyes and certain other tissues. It is diagnosable and curable if recognized early and treated adequately. A twenty nine-year-old male from Jessore, Bangladesh reported in Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh with the complaints of multiple erythematous, large, raised and circumscribed lesions with loss of sensations on different parts of the body, especially distal portions of all four limbs for last eight months. Subsequently he developed ulcers on the anesthetic fingers due to smoking and few ulcerative lesions on both feet. Skin examination revealed multiple erythematous, large nodular lesions on both sides of the cheek and forehead, multiple erythematous, indurated, large plaques with raised margin and central clearing on the trunk, waist and all four limbs, few satellite lesions around the large plaques on the trunk, few hypopigmented patches and plaques on buttock and lower limbs, multiple painless ulcers on dorsal surface of fingers of both hands, both lateral malleoluses and right sole. On examination of peripheral nerves, left great auricular nerve, both ulnar nerves and both common peroneal nerves were moderately enlarged and tender. Slit skin smear for AFB (modified Z-N stain) was done and revealed that there were large number of acid and alcohol-fast bacilli arranged in straight and curved parallel bundles with globular masses (cigar-bundle appearance), morphologically resembling Mycobacterium leprae. Skin biopsy for histopathological examination revealed extensive infiltration of macrophages in the dermis, separated from epidermis by narrow grenz zone, with destruction of skin adnexa. Few foci of poorly defined granuloma in dermis were also noted. The patient was managed with rifampicin, clofazimine, dapsone, prednisolone and omeprazole.

Lepra Dimorfa Lepromatosa (Borderline Lepromatosa, BL) / Dimorphous Lepromatous Leprosy (Borderline Lepromatous, BL

Presentamos un caso de lepra dimorfa lepromatosa, en un hombre austríaco radicado en la Argentina desde hace 40 años, que presentaba placas infiltradas monomorfas y asintomáticas en tronco y miembros, sin alteraciones neurológicas periféricas evidentes. La biopsia de una de las lesiones demostró áreas de hiperplasia fibroblástica perineural "en catafilas de cebolla", granulomas en contacto focal con la epidermis, con transgresión del muro de contención y abundantes bacilos ácido-alcohol resistentes, agrupados en la tinción para micobacterias. El paciente respondió adecuadamente a la terapia con dapsona, rifampicina y clofazimina; sin embargo presentó episodio reacciónal tipo 1 o "reversal", que requirió terapia con prednisona por seis meses.

A case of Dimorphous Lepromatous Leprosy in an Austrian man, who had been living in Argentina for the past 40 years is reported. He presented asymptomatic, infiltrated, monomorphous plaques in his trunk and limbs, without peripheral neurologic manifestations. A skin biopsy specimen obtained from an infiltrated lesion on the back, demonstrated areas of perineural fibroblastic hyperplasia "onion-cataphylls like", granulomas contacting epidermis with violation of the Grenz zone and numerous grouped acid-fast bacilli demonstrated with the Ziehl-Neelsen stain. The patient responded well to therapy with dapsone, rifampicine, and clofazamine, but presented a type 1 reaction (reversal reaction) which required a six-months prednisone therapy.

Cytokine Expression and Cellular Phenotype in Skin Lesions of Borderline Lepromatous Leprosy during Multiple Drug Therapy / 대한피부과학회지

BACKGROUND: Distinct patterns of T cell cytokine production have been shown to influence the outcome of infection. There will be plethora of dynamic changes of T cells and their cytokine production after starting drug therapy in leprosy skin lesions. OBJECTIVE: To determine dynamics of cytokine expression, T cell and macrophage populations in the lesions taken serially in early part of World Health Organization-Multiple Drug Therapy in BL patients. METHODS: Cytokine mRNA expression of TNF-alpha, IFN-gamma, IL-4 and IL-10 in BL skin lesion was detected by RT-PCR analysis. To determine cellular phenotypes of infiltrated cells, immunohistochemical staining method was performed using antibodies to CD4, CD8, CD56, CD57, CD 68, gammadelta-TCR , and S-100 protein. RESULTS: TNF-alpha mRNA, initially showed no consistent change, increased 6 months after MDT. IFN-gamma and IL-10 mRNA showed decreasing tendency initially, but failed to show any consistent increase or decrease after 6 months. IL-4 mRNA was not detected in our patients. In reactional states, mRNA expression of TNF-alpha, IFN-gamma, IL-10 was increased in 2 patients but decreased in 1 patient compared to baseline. Ratio of TNF-alpha positive cells decreased during MDT compared to baseline(p<0.05), but ratio of cells expressing IFN-gamma showed no significant change after MDT. Only CD68 positive cells decreased after MDT(p<0.05). CONCLUSION: Variable treatment induced changes in cellular patterns and cytokine expression within BL lesion observed in this study suggest that complex mechanism of immune systems - including cytokine regulation and defect in macrophages - may exist and be involved in the pathogenesis of leprosy.