Histoid Leprosy Presenting with Borderline Tuberculoid Leprosy in Type 1 reaction: An Uncommon Shift of Spectrum

Histoid leprosy is an uncommon variant of leprosy with characteristic clinical, immunological and bacteriological features and is considered to be a polar variant of lepromatous leprosy. Coexistence of other immunologically diverse forms of leprosy in histoid end of spectrum is very rare. We report a rare case of histoid leprosy on multi-drug therapy for last 7 months shifting to borderline tuberculoid spectrum in type 1 reaction or Wade’s contamination, spectral shift

Sole, An Uncommon Location of Borderline Tuberculoid Hansen’s Disease

Leprosy a chronic granulomatous infection, frequently affects areas with relatively low temperature and which are trauma prone. Areas like scalp, palms and soles, groins, genitalia, axillae, eyelids, and perineum, have been described as “immune” to development of leprosy. But clinic-pathological and bacteriological evidence of involvement of these so-called “immune zones” has rarely been documented. Palmoplantar involvement is uncommon in leprosy and could be easily misdiagnosed. We report here a case of 65-year-old male who had a single, well defined, round, 5*5 cm, dull erythematous to hyperpigmented plaque with central clearing over medial aspect of left foot extension as single, erythematous, roundish 2*2cm, plaque with central clearing over medial aspect of left foot just below ankle, for 3 months. There was decreased sensation to hot and cold temperature and to fine touch and pain over the lesions. Sensory examination elsewhere on the body was normal. There was no motor loss, no thickened nerves, no deformities, trophic ulcers or evidence of reaction. Histopathology of sole lesion suggested borderline tuberculoid Hansen’s disease. Stain for AFB was negative. Slit skin smear was negative. Good response to MDT was seen at end of 4 months. Such presentation needs to be kept mind for diagnosis of leprosy for instituting timely and appropriate treatment

Enfermedad de Hansen: comunicación de un caso de lepra tuberculoide en Chile / Hansen's disease: case report of tuberculoid leprosy in Chile

Resumen La enfermedad de Hansen o lepra es una enfermedad infecciosa crónica causada por Mycobacterium leprae, y que afecta principalmente la piel y nervios periféricos. En los últimos años, se ha logrado un mejor control de la enfermedad en forma global. Sin embargo, en Chile la incidencia de la lepra ha ido en aumento. Presentamos el caso clínico de un paciente de 40 años, haitiano, con lesiones e histopatología compatibles con una lepra tuberculoide. Se discute la importancia en la educación sobre enfermedades menos prevalentes en Chile y se hace una revisión sobre la fisiopatología, clínica y clasificación de la enfermedad de Hansen.

Abstract Hansen's disease or leprosy is a chronic infectious disease caused by Mycobacterium leprae, mainly affecting the skin and peripheral nerves. In recent years, a better control of the disease has been achieved globally. However, in Chile the incidence of leprosy has continued to increase. We present a case of a 40-year-old patient Haitian nationality with lesions and histopathology compatible with tuberculoid leprosy. We discuss the importance of education on less prevalent diseases in Chile, in conjunction with a review of the pathophysiology, clinic, and classification of Hansen's disease.

Lepra lepromatosa macular en la infancia. Presentación de un caso / Lepromatous macular leprosy in childhood. Presentation of a case / Lepra macular lepromatosa na infância. Apresentação de um caso

RESUMEN Introducción: la lepra es una enfermedad infectocontagiosa causada por el mycobacterium leprae, llamada también enfermedad de Hansen en honor a quien descubrió la bacteria en 1873, presenta varias formas clínicas y estados reaccionales que dependen de la inmunidad especifica del huésped. Presentación de caso: paciente masculino de 12 años con diagnóstico de lepra lepromatosa macular caracterizada por máculas hipocrómicas anestésicas y neuritis periférica bilateral y simétrica de los nervios: auricular mayor y cubital, la baciloscopia negativa y el resultado de la histología probablemente lepra. Discusión: en el campo de la Dermatopediatría la lepra sigue siendo una patología poco descrita y subvalorada en la consulta diaria, por ello se convierte en un desafío diagnóstico, debido a la diversidad de manifestaciones clínicas que se pueden presentar, es necesario un minucioso examen cutáneo-neural en todo niño, que presente lesiones cutáneas sugestivas y fuente infecciosa sospechosa. Conclusiones: la presencia de máculas hipocrómicas anestésicas y neuritis periférica bilateral y simétrica de los nervios: auricular mayor y cubital, la presencia antecedentes familiares con la enfermedad y histología probablemente lepra contribuyeron al diagnóstico de una lepra lepromatosa macular.

ABSTRACT Introduction: leprosy is an infectious disease caused by mycobacterium leprae, also called Hansen's disease in honor of the one who discovered the bacteria in 1873. It has several clinical forms and reaction states that depend on the specific immunity of the host. Case presentation: a 12-year-old male patient with a diagnosis of lepromatous macular leprosy, characterized by hypochromic anesthetic macules and bilateral symmetric peripheral neuritis of the nerves: major and ulnar auricular, negative smear and the result of probably leprosy histology. Discussion: in the field of Dermatopediatrics, leprosy is still a pathology that is little described and undervalued in the daily practice, therefore it becomes a diagnostic challenge, due to the diversity of clinical manifestations that may occur, a thorough skin examination is necessary -neural in every child, presenting suggestive skin lesions and suspicious infectious source. Conclusions: the presence of hypochromic anesthetic maculae and bilateral symmetric peripheral neuritis of the nerves: major and ulnar auricular, presence of family history with the disease and probably leprosy histology contributed to the diagnosis of lepromatous macular leprosy.

RESUMO Introdução: A hanseníase é uma doença infecciosa causada pelo Mycobacterium leprae, também chamada de doença de Hansen em honra de quem descobriu a bactéria em 1873, tem várias formas clínicas e estados reacionais que dependem de imunidade do hospedeiro específico. Relato de caso: Paciente do sexo masculino de 12 anos com diagnóstico de lepromatous macular caracterizada por máculas hipocrômicas e neurite periférica bilateral simétrica anestésico eo nervo: auricular e ulnar, o resultado esfregaço negativo e histologia provavelmente lepra. Discussão: No campo da Dermatopediatría lepra é ainda um pouco descrita e subestimado na prática patologia diária, portanto, torna-se um desafio diagnóstico por causa da diversidade de manifestações clínicas que podem ocorrer, um exame da pele completa é necessária -neural em todas as crianças, apresentando lesões cutâneas sugestivas e fonte infecciosa suspeita. Conclusões: A presença de máculas hipocrômicas e nervos neurites periféricas bilaterais e simétricas anestésicos: auricular ulnar e a história da família presença da doença e da lepra histologia provavelmente contribuiu para o diagnóstico de lepromatous macular.

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.

Epidemiological profile of leprosy reactions in a referral center in Campinas (SP), Brazil, 2010-2015

Abstract: Leprosy patients can present reactions during the course of the disease. There are no official data on these reactions in Brazil. We aimed to describe the epidemiological characteristics of patients with such reactions, analyzing information from patient records at a referral center in Campinas (SP), from 2010 to 2015.

A case series of pure neural leprosy in patients diagnosed in a specialized center for the control of Hansen's disease in Colombia / Serie de casos de lepra neural pura en pacientes diagnosticados en un centro especializado en el control de la enfermedad de Hansen en Colombia

Abstract Pure neural leprosy, defined as a peripheral neuropathy in which the patient has no skin lesions, is difficult to diagnose. Its verification by bacteriological index and histopathology is not possible in the majority of the patients. We describe four cases of pure neural leprosy diagnosed by clinical criteria. The clinical outcome of three of the patients after specific treatment was satisfactory, while the other one developed progressive neural damage despite the therapy. All patients were treated in a specialized center for the management and control of Hansen's disease in the municipality of Contratación, Santander, Colombia.

Resumen La lepra neural pura se presenta como una neuropatía periférica sin presencia de lesiones cutáneas. La verificación del diagnóstico mediante el índice bacilary la histopatología, no es posible en la mayoría de los pacientes. Se describen cuatro casos de lepra neural pura diagnosticados por clínica; la evolución de tres de los pacientes que recibieron tratamiento específico fue satisfactoria, en tanto que la otra paciente presentó deterioro progresivo a pesar de las medidas terapéuticas. Todos los pacientes fueron atendidos en un centro especializado en el manejo y control de la enfermedad de Hansen, ubicado en el municipio de Contratación, Santander, Colombia.

Single lesion Lepromatous Leprosy in a teenager: An unexpected scenario

Introduction@#Hansen’s disease (HD) is a chronic granulomatous disease principally affecting the skin and peripheral nervous system caused by Mycobacterium leprae. The incubation period varies from months to more than 30 years. The tuberculoid form of HD usually presents with a single hypoesthetic patch and skin biopsy shows epithelioid granulomas with absence of bacilli on Fite-Faraco stain. In contradistinction, lepromatous leprosy usually presents with numerous papules, plaques and nodules with induration of the ears and nose. Biopsy shows foamy granulomas with presence of acid-fast bacilli on Fite-Faraco stain.@*Case summary@#We present a case of a 13-year old female who presented with a 3-year history of a single hypoesthetic patch on the left knee. The initial clinical diagnosis was tuberculoid leprosy. However, histopathology revealed a Grenz zone, and a nodular granulomatous infiltrate consisting of epitheloid and foamy histiocytes with scattered lymphocytes. Fite-Faraco stain showed a bacillary index (BI) of 3+. Slit-skin smear revealed a BI of 4+. She was then started on multidrug therapy.@*Conclusion@#This case highlights the importance of slit-skin smear and biopsy as routine procedures in all new cases of suspected HD. These procedures will help differentiate multibacillary from paucibacillary forms of the disease which will influence decisions for treatment and prognostication. This case emphasizes that lepromatous leprosy may present with single lesions and may be misdiagnosed as paucibacillary leprosy if skin-slit smear and biopsy have not been done. This case further suggests that there are factors yet undetermined which play significant roles in determining the host response to M. leprae which are believed to influence morphology, configuration, number and distribution of skin lesions.

Analysis of clinical data and T helper 1/T helper 2 responses in patients with different clinical forms of leprosy

Abstract INTRODUCTION: Currently, there are no laboratory tests or sensitive and specific molecular markers for the early diagnosis of leprosy. The aim of this study was to analyze the clinical characteristics of patients with leprosy and investigate their immunological profile, comparing this with the type of lesion and the presence or absence of a Bacillus Calmette-Guérin (BCG) vaccination scar. METHODS: Statistical analyzes were performed by employing comparative tests (Pearson´s chi-square) to evaluate the variables in different clinical forms, considering significance at the 5% level. RESULTS: The study identified a predominance of lepromatous leprosy (26.9%) in patients aged between 34-53 years. Caucasians predominantly had borderline tuberculoid (BT) clinical forms (42%); a predominance of males with borderline lepromatous (19%) and lepromatous leprosy (26.9%) forms was observed; and the presence of BCG vaccination scars (27.5%) and lower limb nerves were more affected (38%) predominantly in the BT clinical form. Significant differences were identified, which included hypochromic lesions predominantly in the BT clinical form (24%); diffuse-type lesions predominantly in the tuberculoid (TT) clinical form (28%); ill-defined lesion border dominance in lepromatous leprosy (LL) clinical forms (30%); an irregular lesion limit predominantly in LL clinical forms (32%); and a predominant Th1 immune response in the BT clinical form (41.7%). CONCLUSIONS: The evaluation of the immunological profile in leprosy patients may contribute to the more detailed diagnosis and possibly better characterization of the prognosis for these individuals.

Enfermedad de hansen (lepra): Eritema nodoso leproso presentación de caso / Hansen disease (leprosy): Erythema nodosum leprosum case presentation

La enfermedad de Hansen o lepra es una enfermedad infectocontagiosa de curso crónico tan antigua como la humanidad misma, que a lo largo de la historia ha marginado a todo aquel que la padece. En la actualidad con el conocimiento de su patogenia y avances en la terapéutica se tiene una visión diferente de la misma. En los siguientes párrafos se realiza una revisión bibliográfica actualizada y la presentación del caso clínico de un paciente de 44 años de edad, al cual se le diagnostico lepra lepromatosa con desarrollo de eritema nodoso leproso quien recibió manejo poliquimioterapéutico con adecuada evolución.

Hansen's disease or leprosy is a chronic course infectious disease as old as humanity itself, which throughout history has led to the isolation and alienation of anyone who has it. Nowadays due to pathogenesis knowledge and therapeutics advance we can have a different point of view about it. In the following sections we will perform an updated revision of this disease and check a 44 year-old patient case, who was diagnosed with lepromatous leprosy developing a nodosum leprosum erythema and who has also received the appropriate multidrug treatment with appropriate clinical response.

Leprosy Scenario at a Tertiary-level Hospital in Navi Mumbai: A Four-year Retrospective Study.

Introduction: India was among the last few countries in the world to achieve leprosy elimination in 2005. However, wide variations in prevalence rates continue to exist across the states and regions in the country. Aims: The purpose of the study is to determine the current clinical profile of leprosy from a tertiary-level hospital in Navi Mumbai. Materials and methods: A retrospective study was done to determine the epidemiological and clinical profile of leprosy patients in a tertiary care center, MGM Medical College & Hospital, Navi Mumbai (September 2011 to August 2015). Data regarding demographic details, clinical features, investigations, treatment, and complications were analyzed. Results: In total, 207 patients were registered over a 4-year period, with male:female ratio of 2.4:1 and children (≤ 14 years) constituting 7.2%. As per Ridley Jopling classification, borderline tuberculoid leprosy was the most frequent morphologic type, seen in 45.8%, followed by borderline lepromatous (28%), lepromatous leprosy (10.1%), and other forms in 11.5%. Multibacillary leprosy was the most common clinical type (81.1%). About 32.8% patients presented in reaction (type I in 22.7% and type II in 10.1%). World Health Organization (WHO) grade 2 deformities were diagnosed in 32.8%, with claw hand being the most common paralytic deformity (18.8%). Conclusion: The study shows that despite statistical elimination, multibacillary disease, leprosy reactions, and deformities are commonly seen as presenting manifestations. Large population of migrant workers in Navi Mumbai could be a possible contributing factor towards these findings. It highlights the need to sustain and provide high-quality leprosy services to all patients through general health services, including good referral system. Investigations, such as slit skin smear and biopsy must be carried out for all newly diagnosed patients.

Differential expression of solute carrier family 11a member 1 and inducible nitric oxide synthase 2 in skin biopsies from leprosy patients.

Background: Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae, an intracellular parasite that resides within macrophages and cannot be eliminated effectively. Solute carrier family 11a member 1 (Slc11a1) and inducible nitric oxide synthase (iNOS), both expressed in macrophages, play major roles in host defense against several intracellular pathogens. However, the roles of these molecules in natural infection with M. leprae remain unknown. Objective: We aimed to investigate the expression of Slc11a1 and iNOS in macrophages (CD68+ cells) infi ltrating skin lesions in leprosy. Methods: Skin biopsies from 48 Mexican patients of leprosy [(33 lepromatous (LL), 15 tuberculoid (TT)] and from 10 healthy controls, were subjected to immunohistochemistry to determine expression of CD68, Slc11a1 and iNOS. Results: We found a high expression of Slc11a1 and iNOS in most lepromatous leprosy samples. In tuberculoid leprosy samples, Slc11a1 expression was moderate or low, and that of iNOS was almost always low. In addition, Slc11a1 and iNOS expression levels were positively associated with bacillary loads in lepromatous leprosy lesions (P = 0.05). Conclusions: These observations suggest that M. leprae infection promotes the expression of Slc11a1 and iNOS in macrophages and that lepromatous leprosy can occur despite this response.

Leprosy in a University Hospital in Southern Brazil

AbstractBACKGROUND:Leprosy is an infectious disease that may lead to irreversible nerve damage, compromising patient's quality of life and leading to loss of working years.OBJECTIVES:To evaluate the epidemiological profile of patients followed at a University Hospital.MATERIALS AND METHODS: This is a retrospective observational study, based on a review of medical records. We studied the clinical and epidemiological features of patients with leprosy monitored at the Hospital de Clínicas of the Federal University of Paraná between January 2005 and January 2010.RESULTS:The mean age was 47.51, while 35.94% of patients were aged 41-60. The male:female rate was 1.8:1. The most prevalent occupations were: retired, students or rural workers. Patients came mainly from Curitiba or nearby areas, but there were also patients from the countryside. The mean diagnostic delay was 24.57 months. Multibacillary forms prevailed, with the lepromatous variety being the most common, closely followed by the borderline type. Neural enlargement was found in more than 50% of the patients and 48.44% of them developed reactional states. Hemolysis was the most commonly detected drug side effect. Initial functional evaluation was possible in 70% of patients, 55% of whom had disabilities upon diagnosis. The most prevalent associated disease was hypertension.CONCLUSIONS:This study showed an important diagnostic delay and a high rate of sequelae in this specific population. Brazil is one of the few remaining countries that has not yet eradicated leprosy and it is important to improve health policies in order to prevent sequelae and achieve eradication.

Follicular mucinosis: an important differential diagnosis of leprosy in an endemic area

Primary follicular mucinosis is a rare dermatosis characterized by the accumulation of mucin in the follicular epithelium and sebaceous glands. Clinically, it is characterized by the presence of papules or well-circumscribed and infiltrated plaques. In this paper, we report the case of a female patient, seven years old, evolving for three months with an asymptomatic, erythematous and infiltrated plaque located in the chin region. The research of thermal, pain and tactile sensitivity was inconclusive. Histological findings confirmed the diagnosis of follicular mucinosis. There was regression of the lesion with the use of medium potency topical corticosteroids for 20 days. The pathogenesis of follicular mucinosis remains unknown, being in some cases associated with lymphoproliferative disorders. In endemic areas of leprosy, isolated and infiltrated follicular mucinosis lesions should be further differentiated from leprosy.

A Case of Tuberculoid Leprosy without Sensory Loss in a Male Immigrant / 대한피부과학회지

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. The prevalence and number of new cases have recently markedly decreased in Korea, and the possibility of leprosy can therefore be clinically overlooked. However, leprosy is still endemic in various regions of the world. A 30 year-old male immigrant from Indonesia presented with an erythematous plaque without sensory loss on his face six months after immigration. The skin lesion was diagnosed as tuberculoid leprosy based on clinico-pathology.

Tuberculoid-type Leprosy Mimicking Tinea Corporis / 대한피부과학회지

A 59 year-old man developed a large, reddish, well-defined, scaly patch on his submental area 37 years before visiting our department; the patch showed central atrophy and was enlarged. He was erroneously treated for tinea corporis at private clinics for 5 years before the correct clinicopathological diagnosis of tuberculoid-type leprosy was made. We report this case to suggest that dermatologists should play an important role in the diagnosis and treatment of leprosy, and that they should pay careful attention while diagnosing new cases of leprosy.

Comportamiento de la lepra en dos policlínicos del municipio La Lisa / Leprosy course analyzed in two polyclinics from La Lisa municipality

La lepra es una enfermedad crónica transmisible tan antigua como el hombre mismo. En Cuba se ha desarrollado un programa nacional orientado a prevenirla, diagnosticarla oportunamente y tratarla de forma adecuada. En este trabajo nos propusimos caracterizar su comportamiento en 2 policlínicos del municipio La Lisa, en el período de 2000 a 2008, estableciendo la relación entre la forma clínica y la demora del diagnóstico en los años estudiados, además caracterizar a los pacientes de acuerdo con su edad, sexo y raza, así como determinar el grado de incapacidad. Se realizó un estudio descriptivo retrospectivo para caracterizar el comportamiento de la lepra, y el universo estuvo constituido por la totalidad de los pacientes con lepra notificados y registrados en los 2 policlínicos en este período. Se confeccionó una planilla que recogió las variables clínicas, sociodemográficas y epidemiológicas. Como registro primario se utilizaron las historias clínicas y las encuestas epidemiológicas de todos los casos de lepra del área objeto de estudio. Se utilizó el método estadístico de por cientos para el procesamiento de los datos que fueron plasmados en las tablas y el texto. Se obtuvo como resultado, cuando se analizó la fecha de diagnóstico con la de los primeros síntomas, según forma clínica de la enfermedad, que el mayor por ciento de los enfermos fueron diagnosticados tardíamente, y de este grupo la forma clínica lepromatosa aportó el mayor número de casos. Es evidente que el año de mayor incidencia de la enfermedad fue el 2008, el grupo etario más afectado está entre los 45 y 54 años de edad, mayormente del sexo masculino, fueron los mestizos los más afectados, y solo 1 paciente con incapacidad grado 2.

Leprosy is a chronic and communicable disease as ancient as the man per se. In Cuba a national program has been developed aimed to its prevention, early diagnosis and treatment in a appropriate way. Aim of present paper was to characterize its course in two polyclinics from La Lisa municipality from 2000 to 2008, establishing the relation between the clinic way and the late diagnosis in study years, and also to characterize patients according to age, sex and race, as well as to determine the inability degree. A retrospective and analytical study to characterize the leprosy course and sample included all the notified and registered leprosy cases in the two polyclinics during this period. A form including the clinical, sociodemographic and epidemiologic variables as well as the epidemiologic surveys of all the leprosy study cases was designed. The statistical percentage method was used for data processing showed in tables and in text. As result, when diagnosis date with the first symptoms was analyzed according to the clinical way of disease, we noted that the higher percentage of sick persons was late diagnosed, and from this group the clinical leprosy presentation provides the great number of cases. It is evident that the year of greater disease incidence was the 2008 one, the more affected age group is between the 45 and 54 years old with a prevailing of male sex and the black people and only one patient with inability degree 2.

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.

A Case of Borderline Tuberculoid Leprosy with Type 1 Reaction / 대한피부과학회지

While leprosy is usually a chronic disease, leprosy reactions may lead to acute problems. These reactions most often occur after initiation of therapy, but can also develop before treatment. We report a case of leprosy type 1 reaction as the first manifestation of borderline tuberculoid leposy. The patient was a 71-year-old woman who had never received treatment for leprosy. She developed multiple erythematous, swollen lesions on has face, extremities and trunk within a few weeks and suffered from paresthesia, numbness and tenderness on those sites. General symptoms were accompanied by fever, malaise, fatigue and loss of appetite. Histological examination revealed multiple tuberculoid granulomas along with neurovascular bundles. A few acid-fast bacilli were detected on AFB stain. The disease was classified as borderline tuberculoid leprosy. The acute neuritis followed by skin lesions represented leprosy with type 1 reaction.

Hanseníase tuberculóide em paciente com Aids / Tuberculoid leprosy in aids patient

Relata-se o caso de uma criança de oito anos, portadora de Aids, que desenvolveu hanseníase tuberculóide antes do início da terapia anti-retroviral. Apresentava lesões ulceradas nos membros, Mitsuda de 8,5mm, hipoestesia em perna esquerda, e o diagnóstico de hanseníase foi definido pela imuno-histoquímica antiproteína S-100, que mostrou fragmentos de ramos nervosos no interior dos granulomas. A incidência da hanseníase não aumentou com o advento da Aids, e não há modificações na apresentação clínica ou na resposta terapêutica nos casos de hanseníase associados à Aids. Também não se observou neste caso o desenvolvimento da reação tipo 1 como resultado da reconstituição imunológica devido ao tratamento anti-retroviral.

The authors present a 8 year-old child with AIDS who developed tuberculoid leprosy prior the beginning of the anti-retroviral treatment. The pacient presented ulcered lesions in arms and legs, the Mitsuda reaction was 8,5 mm, there was hypostesia of the left leg and the leprosy diagnosis was reached mainly supported by the anti-S100 protein immunohistochemistry staining that showed fragments of nerve branches inside granulomas. The incidence of leprosy has not increased because of AIDS. There havenÆt been changes in the clinical presentation and in the response to therapy in cases of leprosy associated with AIDS. We havenÆt also observed development of type 1 reaction in this patient resulting from restoring of the immune response after the anti-retroviral treatment.