RESUMEN
Vascular anomalies are the commonest developmental disorders. Venous malformations (VM) result due todysmorphogenesis in the development of veins. Most commonly these disorders are localized to skin and subcutaneoustissue. Deeper venous malformation may affect the underlying muscle, bone and joints. Early terminalization of hair andincreased sweating in VM plaque has been rarely reported. The present study deals with the case of a 15-year-old boywho had VM involving skin, subcutaneous tissue and bones with terminal hair and increased sweating over the plaque.Radiological examination showed bone hypertrophy with slow flow channels and phleboliths due to superficial and deepVM. He was treated with ethanol sclerotherapy.
RESUMEN
Despite leprosy being an eliminated disease from most of the countries in the world including India, it continues to remain as a major burden on public health expenditure. The purpose of this study was to determine the current clinico-epidemiological profile of leprosy at tertiary care health institution in Himachal Pradesh. This retrospective study was conducted in the Department of Dermatology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. All patients registered from April 2010 to April 2017 were included in this study. Hospital records of 221 patients were analysed according to age, gender, region of permanent residence, history of contact with leprosy patients, number of patients within state or immigrants from nearby state/country, type of disease-multibacillary (MB) or paucibacillary (PB), type of lepra-reactions and grade of disability patient developed. Out of a total 221 patients majority were in the younger age group of 15-30 years (38.9%), with male predominance (male:female ratio 2.7:1). Majority had MB leprosy (85.5%), and had significant proportion of grade II disability (G2D) compared to national and global data. In clinical disease spectrum, Lepromatous Leprosy (LL) and Borderline lepromatous (BL) leprosy were the most common presentations. Migrants from other states or immigrants from neighbouring country constituted a significant proportion (44/221, 20% approximately). Pure-neuritic disease was diagnosed in 7 (3.2%) patients, childhood cases were only 5 (2.3%) patients, indeterminate leprosy in 3 (1.4%) patients and histoid leprosy in 1 patient (0.004%). To know the exact status of leprosy in the country, knowledge and understanding of the epidemiological profile is an essential pre requisite as it will assess and address public health needs and will help in efficient programme planning and management of leprosy cases in the country. High proportion of MB cases and very high disability percentage shows the need to increase the awareness in the community as well as health care workers so that cases report early, are diagnosed early and managed appropriately so that disabilities become zero in near future. Partnerships among different medical institutions in the state are expected to strengthen the quality referral services and research aimed at eradication.
RESUMEN
Type 2 reactions may occur in the early stages of the anti-leprosy treatment, however, many cases may present 2–3 years after leprosy diagnosis. Some of such patients have been reported to develop episodes as late as 7 years after starting treatment. A 45 years old male, with a past history of intake of multi drug therapymultibacillary (MDT-MB) pack 15 years back presented with fever, generalized bodyache along with development of vesiculo-bullous lesions over the existing annular lesions of borderline lepromatous (BL) leprosy. Possibility of relapse was ruled out clinically as well as histopathologically and the patient was successfully treated with tapering doses of steroids as a case of severe type 2 reaction. Type 2 reaction is less commonly seen in BL leprosy as compared to lepromatous lepromatous (LL) leprosy. Moreover, development of vesiculo-bullous lesions in an annular pattern over existing lesions of BL leprosy as a manifestation of type 2 reaction has rarely been reported in literature. This case is even rarer as the patient is continuing to get type 2 reaction even after 15 years of completion of MDT-MB and that too in an annular pattern over the existing lesions.