Rare Variant of Leprosy Reaction (Lucio Phenomenon): A Case Series.

ABSTRACT: Lucio phenomenon (LP) is a variant of type two leprosy, characterized by necrotizing erythema, frequently found in neglected leprosy patient who experience delayed diagnosis or inappropriate treatment. Indonesia is in the third place for highest leprosy cases worldwide. Nonetheless, LP is less common, regardless being an endemic country. In this serial case, we describe the three cases of LP in lepromatous leprosy patients in Denpasar, Bali. All three cases came to our hospital with chronic wounds complained up to a year, accompanied by swollen leg, blisters, tingling sensation, and other symptoms. They had received no suitable treatment, proving LP as a neglected case in primary health care. After a period of treatment, however, patient lesions improved clinically with no physical disability. With this case series, a better understanding toward LP initial complains together with its natural history and further examination could be achieved; thus, improving the early diagnosis and management of LP.

Association of testosterone level with melasma in men: a case-control study in Indonesia.

Introduction: melasma is a common acquired hypermelanosis which occurs mostly in face that caused by many factors. One of the pathogenesis of melasma in men is affected by testosterone. This study aimed to investigate the relationship between testosterone levels and melasma in men and its association with the severity of melasma as measured by the melasma area and severity index (MASI) score. Methods: a case-control study involving 30 subjects with melasma and 30 subjects without melasma who were treated at the outpatient clinic of Dermatovenereology of Ngoerah General Hospital from June to August 2022. Descriptive statistical analysis is to determine frequencies and percentages. Bivariate analysis was used to find any risk factor between testosterone level and melasma. Data obtained from the two groups then analyzed for correlation between the MASI score and testosterone levels. Results: mean age of the subjects in the melasma group was 43.83±6.30 and in control group was 43.80±6.09. Mean testosterone level in the melasma group (7.55±1.77) was significantly lower than the control group (21.07±6.65; p = 0.001). Subject with testosterone level ≥8.92 nmol/L has 6.9 times risk of melasma compare to control (aOR: 6.986, 95% CI 1.905-25.622; p = 0.003). Conclusion: low testosterone levels possibly have a role in pathogenesis of melasma in men.

Correlation of Plasma Level of Insulin-Like Growth Factor-1 (IGF-1) with Bacterial Index on Leprosy Patients in Bali.

BACKGROUND: Leprosy is an infection by Mycobacterium leprae, which influenced by cellular immunity. Leprosy tends to occur in low socio-economic and nutrition groups. Researchers try to prove the role of nutrition in the pathogenesis of leprosy. Insulin-like growth factor-1 (IGF-1) as a marker of nutritional status shown to play a role in cellular immunity. OBJECTIVE: To evaluate the correlation between IGF-1 with bacterial index (BI) on leprosy patients in Bali. METHODS: Cross-sectional study in Sanglah Public General Hospital, Denpasar of patients with paucibacillary (PB) and multibacillary (MB) leprosy were assessed for BI using slit-skin smear. All patients were tested for plasma IGF-1 using chemiluminescent immunometric assay Immulite. All data were analyzed using IBM SPSS ver. 24.0. The study has been approved by local Institutional Review Board with ethical clearance number 2017.02.1.0356. RESULTS: Our study involved 44 MB and 2 PB leprosy. The common age group affected was between 31~40 years old (23.9%), male (60.9%), and normal body mass index (BMI) (65.2%). Mean plasma IGF-1 level in PB leprosy was higher (91.07±0.74 ng/ml) than MB (82.74±6.44 ng/ml). The mean IGF-1 level decreases as BI increases in both groups (CI 95%=81.16~85.04; p<0.001). Pearson correlation test shows strong negative correlation (Pearson r=-0.976; p<0.001) with determinant coefficient (R2) showing 95.2% (p<0.001). CONCLUSION: In Balinese leprosy patients, severity of disease status measured by BI were found to be strongly correlated with the plasma IGF-1 level which may help preventing transmission in household contacts by improving nutritional status.

Detection of serum antibodies to M. leprae major membrane protein-II in leprosy patients from Indonesia.

BACKGROUND: Sero-diagnostic methods are the easiest way of diagnosing an infectious disease in developing countries. In leprosy, phenolic glycolipid-1 (PGL-I) based methods for the detection of leprosy are currently available, but the use of these methods has been hindered due to the inherent problems of sensitivity. We previously showed that antibodies to Major Membrane Protein-II (MMP-II) derived from Mycobacterium leprae could be used to diagnose leprosy in Japan. METHODS: Sera from patients and healthy individuals were collected with informed consent and the anti-MMP-II antibody levels of the sera were measured by enzyme-linked immunosorbent assay. The study was conducted at South Sulawesi and Bali, in Indonesia. The study population included 40 each of multibacillary leprosy and paucibacillary leprosy patients, 30 tuberculosis and 16 patients with typhoid. RESULTS: We evaluated the anti-MMP-II antibody levels in Indonesian individuals. The cut-off value was determined from receiver operator characteristic curve as 0.124 using the O.D. titers for patients with multibacillary leprosy, so that the sensitivity of the test was 97.5% and the specificity taking healthy individuals as controls was 984%. Using the determined cut-off values, 98% of multibacillary (MB) leprosy and 48% of paucibacillary (PB) leprosy patients had positive levels of anti-MMP-II antibodies, 13% of patients with typhoid and 22% of the household contacts of MB leprosy had positive levels of anti-MMP-II antibodies. CONCLUSIONS: Our results suggest that measuring anti-MMP-II antibody levels could facilitate the detection of leprosy in endemic countries.