ABSTRACT
Atypical presentations can be expected when leprosy, a mycobacterial disease is associated with HIV. We report a case of a 28 year old male driver with a high risk behavior, who came for evaluation of hypoaesthetic, scaly erythematous plaques over face, trunk, upper extremity; verrucous lesions over elbows and necrotic lesions over the neck and lower extremities since 6 months. No other systemic complaints were present. Nerve examination showed grossly thickened left greater auricular nerve and cord like thickening of bilateral ulnar and lateral popliteal nerves. His investigations revealed anemia, a reactive ELISA for HIV-1 and CD4 of 400 cell/cmm. Ultrasonography of the thickened nerves revealed an abscess in the left ulnar nerve whereas the left greater auricular nerve showed neuritis. Histopathology from an erythematous plaque was suggestive of borderline tuberculoid leprosy in reaction. Final diagnosis was borderline tuberculoid leprosy in type 1 reaction with atypical and varied morphology in an immunocompromised male with neuritis of the left greater auricular nerve, a silent left ulnar nerve abscess with early left ulnar nerve palsy. Our case highlights the atypical morphology of leprosy lesions and the unexpected protective cellular response as suggested by formation of nerve abscess in a HIV positive patient.
Subject(s)
HIV Infections/complications , HIV-1/isolation & purification , Leprosy, Borderline/diagnosis , Leprosy, Tuberculoid/diagnosis , Peripheral Nerves/pathology , Abscess/complications , Abscess/pathology , Adult , Diagnosis, Differential , HIV Infections/diagnosis , HIV Infections/pathology , HIV-1/immunology , Humans , Leprosy, Borderline/complications , Leprosy, Borderline/pathology , Leprosy, Tuberculoid/complications , Leprosy, Tuberculoid/pathology , Male , Neuritis/complications , Neuritis/pathology , Peripheral Nerves/diagnostic imaging , Skin/pathology , Ulnar Nerve/pathology , UltrasonographyABSTRACT
BACKGROUND: Prostaglandin E2 (PGE2) has stimulant and immunomodulatory effects on melanocytes and regulates their proliferation. OBJECTIVES: To study the efficacy and safety of topical PGE2 in treating stable vitiligo patches involving <5% body surface area. METHODS: Fifty-six consecutive patients with clinically diagnosed stable vitiligo of types vulgaris, focal, segmental, lip and genital applied a translucent PGE2 (0.25 mg g(-1)) gel twice daily for 6 months. Evaluation was fortnightly for 3 months and monthly thereafter up to 6 months. Assessment was based on degree of repigmentation in treated patches ranging from 0% (no change) to 100% (complete repigmentation). Overall response was graded as: poor, 1-25% repigmentation; moderate, 26-50%; good, 51-75%; excellent, >75%. RESULTS: Vitiligo vulgaris was the most common type (n=22; 39%), followed by focal and lip vitiligo, with lesions being mostly on the face (25%) and lips. Repigmentation was seen in 40 of 56 patients (71%), with mean onset at 2 months. Patients with disease duration of 6 months or less repigmented best, with face and scalp responding earliest (1-1.5 months). Complete clearance occurred in eight of 40 patients, six of the eight having face lesions. Excellent response was seen in 22 of 40 patients. All neck, scalp and trunk lesions, 33% genital, 29% lip vitiligo, 100% segmental and 63% focal patches showed moderate to excellent response. Incidence of side-effects was 18%, mainly a transient burning sensation especially on the lips. CONCLUSIONS: The efficacy and safety of topical PGE2 make it a promising therapy for localized stable vitiligo.
Subject(s)
Dermatologic Agents/therapeutic use , Dinoprostone/therapeutic use , Vitiligo/drug therapy , Administration, Cutaneous , Adult , Dermatologic Agents/adverse effects , Dinoprostone/adverse effects , Female , Humans , Male , Patient Satisfaction , Severity of Illness Index , Sex Factors , Treatment Outcome , Young AdultABSTRACT
Hematohidrosis is a very rare condition of sweating blood. A case of hematohidrosis is reported. There are only few reports in the literature.
