A patient with erythema nodosus leprosum and Chagas cardiopathy: challenges in patient management and review of the literature.

We report a patient with severe multi-bacillary leprosy complicated by recurrent episodes of erythema nodosum necrotisans that required thalidomide and/or corticosteroids during follow-up. Although the patient was from an area to which Chagas disease is endemic, this diagnosis was initially missed and was only investigated when heart failure developed in the patient. The difficulties of managing erythema nodosum necrotisans and heart failure concomitantly and those involved in excluding the diagnosis of acute myocarditis caused by reactivation of Chagas disease secondary to the immunosuppressive regimen are discussed. Other potential causes for the heart failure and possible interactions between the two diseases and their treatments are discussed. We also reviewed the literature for the association between leprosy and Chagas disease, both of which are highly endemic in Brazil. This case emphasizes the importance of searching for subclinical co-infections in leprosy patients because reactions frequently develop during specific treatment in these patients, and these reactions require prolonged therapy with immunosuppressive drugs.

Primary orbital melanoma associated with a blue nevus.

A 43-year-old white woman presented with a sudden pain and protrusion of the right eye, along with decreased vision. Orbital CT revealed a well-demarcated lesion in the right intraconal space. After surgical excision, the histopathologic examination revealed a malignant melanoma with a predominant epithelioid cell type, probably arising in a blue nevus. The patient was treated with exenteration followed by radiotherapy.