ABSTRACT
A 37-year-old male presented with severe oral and genital mucosal ulcers, lichenoid eruption and twenty-nail dystrophy. Systemic examination was normal, except for anemia. On investigations, he was found to have persistently elevated peripheral eosinophilia, absolute eosinophil count >5000/mm(3), bone marrow showing increased eosinophilic precursors, and infiltration by atypical cells. The serum vitamin B12 levels were grossly elevated, and Philadelphia chromosome study was negative. Thus, a diagnosis of chronic eosinophilic leukemia was made. The patient showed excellent response to imatinib mesylate. We are reporting a rare type of leukemia presenting with predominantly cutaneous manifestations.
ABSTRACT
Immune reconstitution inflammatory syndrome is characterized by a paradoxical worsening of an existing infection or disease process, soon after initiation of highly active antiretroviral therapy. The first case of leprosy presenting as immune reconstitution inflammatory syndrome was published in 2003. Here we report a case of Hansen's disease borderline tuberculoid presenting with type 1 lepra reaction 5 months after initiation of highly active antiretroviral therapy.
ABSTRACT
BACKGROUND: India has declared leprosy to be eliminated in the country, according to the WHO criteria of attaining a prevalence of less than 1 in 10,000. However, smear-positive leprosy cases are frequently being encountered. METHODS: This is an 18-year retrospective study done in the Department of Dermatology and Venereology, Government Medical College, Trivandrum. Data were collected from the records of all cases in the study period, and the prevalence of smear-positive cases was determined in the post-elimination phase and this was compared to the pre-elimination phase. RESULTS: A total of 901 cases were analyzed, which comprised 538 cases in the pre- and 363 cases in the post-elimination phase. The male/female ratio in the pre and post phases was 2.61 : 1 and 2.45 : 1, respectively. Borderline tuberculoid accounted for the commonest type in both the pre and post phases comprising 45.54 and 50.69%, respectively. Type 2 lepra reactions were seen in 40.21% of the reaction cases in the post-elimination phase. The smear-positive cases in the post-elimination phase accounted for 34.99% compared to 14.68% in the pre-elimination phase. Lepromatous leprosy (LL) accounted for 67.71% of the smear-positive cases in the post phase compared to 67.08% in the pre phase. CONCLUSIONS: There was an increase of 20.30% of smear-positive cases in the post-elimination phase, which was statistically significant (P < 0.001), and the majority of them were LL (P < 0.001).
