Lepra ocular: a propósito de un caso / No disponible

La detección temprana y tratamiento de las afecciones oculares en pacientes con enfermedad de Hansen es muy importante ya que generalmente tienen un carácter crónico y son de difícil manejo pudiendo llevar al paciente a la disminución de la visión y/o ceguera. Las inflamaciones intraoculares se encuentran entre las complicaciones oculares que pueden presentarse en estos pacientes (4.6%). Se presenta un caso de una paciente femenina de raza negra de 42 años con diagnóstico de enfermedad de Hansen desde el año 2015 (Lepra Lepromatosa) llevando tratamiento completo con multidrogas durante un año. Se remite al servicio de Uveítis del Instituto Oftalmológico Ramón Pando Ferrer, diagnosticándose una panuveítis bilateral granulomatosa. Se indicó tratamiento intensivo con midriáticos, esteroides tópicos y en alta dosis por vía oral, con reducción progresiva de los mismos, logrando el control de su enfermedad ocular y mejoría de la agudeza visual. Las características de este tipo de paciente requieren una valoración personalizada. Por esto se presenta su manejo clínico y evolución

The early detection and treatment of ocular affections in patients with Hansen’s disease is very important since they are usually of a chronic nature, they are difficult to manage and may lead the patient to decreased vision and/or blindness. Intraocular inflammations are among the ocular complications that can occur in these patients (4.6%). We describe a case of a 42-year-old black female patient diagnosed with Hansen’s disease since 2015 (Leprosy Leprosy) taking complete treatment with multidrug therapy for one year. She referred to the Uveitis Department of the Ramón Pando Ferrer Ophthalmological Institute and was diagnosed of a bilateral granulomatous panuveitis. Intensive treatment was indicated with mydriatics, topical and high oral doses of steroids. A progressive reduction of them, achieved control of the ocular disease and improvement of visual acuity. The characteristics of this type of patient require a personalized assessment. This is why we present its clinical management and evolution

Dermatoscopy in leprosy and its correlation with clinical spectrum and histopathology: a prospective observational study.

BACKGROUND: Leprosy, a chronic granulomatous infection has varied clinical presentations spanning across different spectrums. The scope of dermatoscopy is vast and has been studied for other granulomatous disorders like sarcoidosis. OBJECTIVES: The objective of this study was to describe the dermatoscopic features of the entire spectrum of leprosy and to correlate with clinical and histopathological findings. METHODS: This was a prospective observational study of treatment naïve leprosy patients over a period of 1 year. The study patients were categorized as per Ridley-Jopling classification based on clinical, slit skin smear and histopathological findings. Most representative lesions were photographed, evaluated by dermatoscopy and were biopsied. RESULTS: A total of 30 patients (21 males and 9 females) were recruited; 2 cases of tuberculoid leprosy, 12 cases of borderline tuberculoid (3 with type 1 reaction), 8 cases of borderline lepromatous, 6 cases of lepromatous leprosy (3 with type 2 reaction) and 2 cases of Histoid leprosy. The dermatoscopic featues consistently seen were yellowish orange areas and vascular structures like linear branching vessels and crown vessels correlating with the presence of dermal granulomas and dilated vessels. Broken pigment network, white chrysalis like areas were seen in addition. Tuberculoid spectrum also had absence of or diminished hair follicles and eccrine duct openings correlating with presence of peri-appendageal granuloma and appendageal destruction. Scaling and follicular plugs were other features in lesions of type 1 reaction. CONCLUSION: Yellowish-orange areas and vascular structures are the common dermatoscopic features of leprosy. Broken pigment network and paucity of appendageal structures are additional specific features.

Nailfold capillaroscopy in leprosy.

Due to mounting evidences of interaction between Hansen's bacilli with endothelial cells and the paucity of studies addressing the presence of nailfold capillaroscopic alterations in patients with Hansen's disease, a study was carried out in order to verify the presence of capillaroscopic alterations in patients with leprosy in its various forms and its correlation with clinical parameters. Ten patients were evaluated at a specialized university service. Sixty percent of those had some capillaroscopic change, such as micro-hemorrhages, ectatic, bushy and corkscrew capillaries. Such changes were unspecific, which suggests there is not a specific pattern for this disease.

Neuromuscular ultrasonography: quantifying muscle and nerve measurements.

Neuromuscular ultrasonography can be used both descriptively and quantitatively in the evaluation of patients with neuromuscular disorders. This article reviews the quantitative use of this technology, particularly measurements of the size and echogenicity of nerve and muscle, as a tool for assessing the severity, progression, and response of these tissues to therapeutic interventions. Neuromuscular ultrasonography has several features, including portability and noninvasiveness, that make it an attractive research tool for advancing the diagnosis and treatment of neuromuscular disorders.

Use of fine needle aspiration cytology in leprotic lesions: a report of 4 cases.

BACKGROUND: Although a few studies have shown fine needle aspiration cytology (FNAC) to be a sensitive diagnostic tool in the detection of nerve involvement, its role as an initial diagnostic procedure in pure neuritic leprosy (PNL) and in the detection of skeletal lesions with unusual findings has not been documented before. CASES: Three patients who presented with thickened nerves and a fourth with biopsy-proven lepromatous leprosy with lesions in hand bones underwent FNAC. Of the 3 patients with nerve thickening, 2 had a clinical suspicion or diagnosis of neuritic leprosy, whereas in the third patient a clinical differential diagnosis of a soft tissue tumor or parasitic cyst was considered. FNAC in all 3 cases revealed epithelioid cell granulomas, Langhans giant cells and caseous necrosis. Fites and Ziehl-Neelsen stains were negative for acid-fast bacilli. Cytologic diagnosis of pure neuritic leprosy was made in all 3 cases and confirmed by histopathologic examination. FNAC of skeletal lesions from the fourth patient confirmed involvement of bone with unusual cytologic findings of epithelioid cell granulomas and giant cells along with a significant proportion of foamy macrophages and strong Fites stain positivity. CONCLUSION: FNAC is a simple, useful, minimally traumatic and routinely applicable procedure in the diagnosis of pure neuritic leprosy and leprous osteitis.

Paranasal sinus computed tomography findings in patients treated for lepromatous leprosy.

AIM: Nasal and paranasal sinus involvement is common in lepromatous leprosy and is of considerable epidemiological significance. The aim of this study was to investigate paranasal sinus abnormalities in treated lepromatous leprosy cases and to evaluate the findings in comparison with those of previous studies. MATERIALS AND METHODS: Thirty-eight patients who had been treated for lepromatous leprosy were included. All patients had been treated with dapsone and rifampicine for six months, and followed with dapsone, rifampicine and clofamizine for a minimum of two years. All patients received a clinical examination, a coronal computed tomography (CT) examination of the paranasal sinuses and ethmoidal sinus endoscopy, in order to investigate the involvement of the paranasal sinuses in the leprosy. Ethmoidal sinus biopsies were taken in 18 of the 21 cases of ethmoidal sinus involvement noted on CT scan. RESULTS: Twenty-three patients had sino-nasal symptoms. Endoscopic examination showed different pathologies in 21 of these patients. Abnormalities in the paranasal CT images were observed in 27 patients. The ethmoidal, maxillary, frontal and sphenoid sinuses were affected in 21, 18, three and two patients, respectively. Various degrees of nasal septum perforation were noted in 18 cases. In six of the 18 patients biopsied, the biopsy specimen showed involvement by lepromatous leprosy. CONCLUSION: These findings suggest that although these lepromatous leprosy patients had been treated, persistent infection was still commonly encountered. Paranasal sinus CT examination is a useful method for the evaluation of patient response to treatment and follow up; however, a CT scan alone cannot determine whether the leprosy is active.

CT findings in involvement of the paranasal sinuses by lepromatous leprosy.

The role of nasal infection in the transmission of leprosy has been extensively studied. Leprosy can affect the paranasal sinuses due to mucosal continuity and bacillaemia. This prospective study was performed on 25 untreated patients with lepromatous leprosy. 5 mm contiguous axial and coronal CT sections of paranasal sinuses, on soft tissue and bone windows, were obtained in all patients. Each sinus was examined for mucosal thickening, soft tissue densities and bony outlines. Representative biopsies were taken from ethmoid sinus to confirm the radiological diagnosis in 12 patients with multiple paranasal sinus involvement. Ethmoid aircells were involved in 20 patients (80%). Maxillary, frontal and sphenoid sinuses showed abnormalities in 12, four and three patients, respectively. The ethmoid biopsy showed involvement by lepromatous leprosy in seven of 12 patients (58.3%). Involvement of paranasal sinuses is common in lepromatous leprosy and is of considerable epidemiological significance.

Computed tomographic study of paranasal sinuses in lepromatous leprosy.

Twenty patients (18 males, 2 females) with lepromatous leprosy and 10 age- and sex-matched controls were subjected to computed tomographic (CT) scans of the paranasal sinuses (PNS). The mean bacterial (BI) and morphological indexes were 3.4+ and 1%, respectively. Nasal symptoms were present in nine (45%) patients; 15 (75%) out of 20 patients showed significant abnormalities on CT scans of the PNS compared to none of the 10 controls. The maxillary and ethmoid sinuses were affected in 11 (55%) patients each, followed by the sphenoid sinus in four (20%) patients. Frontal sinus involvement was least frequent, only one (5%) patient showed CT changes. Mucosal thickening was the most common finding followed by soft-tissue densities and, rarely, a fluid level was seen in the PNS. Involvement of the PNS correlated with a high BI of 4+ or more (75% vs 37.5%). Paranasal sinus involvement is an integral part of lepromatous leprosy since histological involvement was present even when the CT scan was apparently normal.

Study of ethmoid sinus involvement in multibacillary leprosy.

The nasal mucosal involvement in lepromatous leprosy is well recognized. Currently interest has centred around the involvement of paranasal sinuses in leprosy. They act as a reservoir and constant source of reinfection to the nasal mucosa. In the present prospective study 25 untreated patients with multi-bacillary leprosy were included. Clinical examination, computed tomography (CT) scan of paranasal sinuses, ethmoid sinus endoscopy and biopsy were carried out in all patients, to investigate the involvement of the paranasal sinuses in leprosy. Ethmoid sinus involvement was noted in 20 patients on CT scan. Bilateral involvement was more common (65 per cent). Anterior ethmoids were more commonly affected (65 per cent). On ethmoid sinus endoscopy abnormal mucosa was noted in 17 patients (68 per cent). Ethmoid sinus biopsy was confirmative in 16 patients (64 per cent). Statistically significant correlation was found between CT findings, sinus endoscopy and sinus biopsy findings.

Gallium-67 scintigraphy in borderline lepromatous leprosy.

A middle aged woman with a pyrexia of unknown origin was shown to have borderline lepromatous leprosy. Early gallium-67 scintigraphy demonstrated increased uptake in the subcutaneous tissues of the face and thighs. As a result of these findings skin biopsy was obtained from the right thigh which gave a diagnosis of borderline lepromatous leprosy. The authors have been unable to find other reports of gallium-67 scintigraphy in leprosy but the pattern of gallium-67 distribution should suggest the diagnosis.

A clinical and radiological study of maxillary antrum in lepromatous leprosy.

Seventy consecutive patients having multibacillary leprosy were questioned about symptoms of nasal involvement and sinusitis. Complete otorhinolaryngeal examination was carried out in all these patients and they were subjected to radiographic examination of paranasal sinuses. Radiological abnormality of maxillary antrum was found in 40 (57%) patients. Radiological changes were unilateral in 25 and bilateral in 15 patients. Localised or generalised mucosal thickening was the most common finding, followed by diffuse opacity. The development of radiological changes in maxillary antrum correlated with high bacterial density (BI 3+ and above), nasal deformity, and disease duration of more than two years.

Radiological study of the paranasal sinuses in lepromatous leprosy.

Thirty patients of lepromatous leprosy have been studied by radiological investigation for affection of paranasal sinuses. It has been found that leprosy involves all groups of sinuses and maxillary antrum is found to be more commonly affected. Diffuse hypertrophy type of lesion is more commonly recorded in maxillary antrum, in x-ray of paranasal sinuses. The clinical significance and importance of extension of disease in the sinuses is discussed in the light of available literature.