Diagnosis Of Lepromatous Leprosy Research Articles

LEPROMATOUS LEPROSY: A CASE REPORT

Hansen's disease, also known in the past as leprosy, is an infectious disease that remains endemic in >140 countries around the world and it remains a major health care problem in many underdeveloped and developing countries like India and Brazil. The risk of transmission is increased for individuals living in close contact with patients with leprosy, most likely through infectious aerosols but possibly also through direct contact. This study repots a case of a 52-year-old male patient presenting multiple well-defined cutaneous and oral variable-sized nodules and with hypoesthesia. The clinical diagnostic hypotheses were leprosy, Von Recklinghausen's neurofibromate, Kaposi's sarcoma, leishmaniasis, syphilis, paracoccidioidomycosis, lobomycosis, or xanthomatosis. An incisional biopsy was performed from the oral lesion. The histopathologic examination showed chronic inflammatory infiltrate rich in macrophages forming granulomas and neural invasion. Positivity was found for CD68, S100, and Ziehl-Neelsen staining. The diagnosis of lepromatous leprosy was made. The patient is in follow-up. Hansen's disease, also known in the past as leprosy, is an infectious disease that remains endemic in >140 countries around the world and it remains a major health care problem in many underdeveloped and developing countries like India and Brazil. The risk of transmission is increased for individuals living in close contact with patients with leprosy, most likely through infectious aerosols but possibly also through direct contact. This study repots a case of a 52-year-old male patient presenting multiple well-defined cutaneous and oral variable-sized nodules and with hypoesthesia. The clinical diagnostic hypotheses were leprosy, Von Recklinghausen's neurofibromate, Kaposi's sarcoma, leishmaniasis, syphilis, paracoccidioidomycosis, lobomycosis, or xanthomatosis. An incisional biopsy was performed from the oral lesion. The histopathologic examination showed chronic inflammatory infiltrate rich in macrophages forming granulomas and neural invasion. Positivity was found for CD68, S100, and Ziehl-Neelsen staining. The diagnosis of lepromatous leprosy was made. The patient is in follow-up.

Lepromatous leprosy mimicking systemic lupus erythematosus

We describe a case of a 36-year-old woman who presented with bilateral symmetrical polyarthritis of the hands, malar rash, and discoid rash over three months. She was initially diagnosed and treated as systemic lupus erythematosus but later proven to have lepromatous leprosy. The patient showed a remarkable improvement after the administration of steroids. Due to typical features of a connectivetissue disorder, a positive serological marker, photosensitivity, typical age of onset and initial response to treatment led to the confusion and delay in diagnosis of lepromatous leprosy. Further, this case emphasizes the importance of obtaining a detailed contact history and taking a skin biopsy even in a typical connective tissue lesion. Our case illustrates an unusual presentation of lepromatous leprosy mimicking systemic lupus erythematosus.

P.137 A case of leprosy in the UK

Introduction: Leprosy is a multi-system disease caused by Mycobacterium leprae. Whilst uncommon in the developed world, cases continue to rise in developing nations with up to 200,000 new cases reported annually. 1We report a case of lepromatous leprosy in a parturient residing in Scotland. Case Report: A 26-year-old primigravida presented in early pregnancy following a history of nosebleeds and widespread rash. The patient was a sickle-cell carrier but was otherwise well with no allergies. A diagnosis of lepromatous leprosy with erythema nodosum reaction was made and treatment commenced with prednisolone and combination therapy with rifampicin, clofazimine and dapsone. The pregnancy was complicated by anaemia and thrombocytopaenia with mild splenomegaly. Anaemia was thought to be secondary to Dapsone-related haemolysis, and thrombocytopaenia was thought most likely to be gestational. She developed neuropathic leg pain and hypoaesthesia but this resolved during the pregnancy. Renal and liver function remained normal and there were no symptoms or signs of autonomic dysfunction with normal postural blood pressure readings and normal ECG. After multi-disciplinary discussion, induction of labour was planned due to concerns over fetal growth. The patient was screened for SARS-CoV-2 and this was positive, though the patient remained asymptomatic. The patient was not considered to be infectious and standard infection control procedures were observed. Anaesthetic options for analgesia in labour and anaesthesia for potential operative delivery were discussed at several occasions during pregnancy and ”OAA Labour Pains” translated information sheets were given to the patient. Following induction of labour, the patient had a spontaneous vaginal delivery with no anaesthetic intervention required. Discussion: Leprosy is uncommon in developed nations but may occur in the UK as the population becomes more diverse. Leprosy raises many potential challenges for the anaesthetist including;cutaneous changes (which may be of particular significance if occurring over sites of intravenous access or lower lumbar region), neuropathies, myopathies, autonomic dysfunction, haematological derangements (including anaemia, thrombocytopaenia and agranulocytosis) and liver and renal impairment. Drug therapies for leprosy may in themselves be associated with blood dyscrasias, hepatitis, psychosis, and peripheral neuropathies. Anaesthetic management should be informed by the presence of any complications, most notable thrombocytopaenia or peripheral neuropathies. The possibility of autonomic dysfunction should be considered regardless of which anaesthetic modality is chosen and care taken to actively manage hypotension. The patient’s SARS-CoV-2 status was a further factor influencing the risk-benefit assessment of anaesthetic options in this case.

Erythema nodosum leprosum

Erythema nodosum leprosum (ENL) is a type 2 reaction, which is a humoral response to Mycobacterium Leprae infection. The fig. 1 and 2 depict the presentation of a 30-year-old with arthritis of large joints and dactylitis. Since 2 years, he had progressive nodular ulcerative lesions over trunks, thighs and upper-extremities (Fig. 3, 4, 5 and 6), and madarosis and nodular lesions on both the ear lobes (Fig. 7 and 8). Further evaluation of skin biopsy and histopathological examination confirmed the diagnosis of lepromatous leprosy with type 2 reaction.

Wade histoid leprosy revisited

An 18-year-old man presented with a 4-year history of erythematous patches on the trunk, followed 2-years later by multiple nodules, mostly located on the limbs, and distal paresthesias. Two close contacts were treated for leprosy during his childhood. Histopathological examination revealed a histiocytic infiltrate with acid-fast bacilli on Ziehl-Neelsen stain. The slit-skin and nasal smears showed numerous acid-fast bacilli. The correlation between clinical, epidemiological, histopathological, and microbiological features allowed the diagnosis of lepromatous leprosy, histoid variant. Multidrug therapy as recommended by the WHO was initiated. A rapid and sustained improvement was seen. Histoid leprosy is a rare manifestation of lepromatous leprosy, first described by Wade in 1960. Since then few cases have been reported, the majority of them from countries with a high prevalence of the disease. Early recognition and treatment are of most importance to prevent neurological disabilities and achieve epidemiological control.

Association between -173 G/C polymorphism of MIF and the susceptibility to develop lepromatous leprosy in mestizo patients from western Mexico

Association between -173 G/C polymorphism of MIF and the susceptibility to develop lepromatous leprosy in mestizo patients from western Mexico

Tufted angioma in ear auricle: importance of the differential diagnosis

Tufted angioma is an acquired vascular proliferation with specific histological characteristics. The most common clinical features are erythematous macules. It occurs predominantly in children and young adults, especially in the chest and neck. We report the case of a male patient, 12 years old, with an increased right ear auricle associated with erythematous macules and increased local temperature, referred with a diagnosis of lepromatous leprosy; however, this diagnosis was questioned. Histopathology was consistent with tufted angioma.

Leprogenic odontodysplasia: new evidence from the St. Jørgen’s medieval leprosarium cemetery (Odense, Denmark)

Leprogenic odontodysplasia (LO), also known as dens leprosus, consists of anomalous root development of the permanent upper incisors. This dental anomaly was first reported by Danielsen in 1968 among Danish juvenile skeletons from medieval leprosaria cemeteries. As yet, no clinical cases have been documented and the etiological and epidemiological significance of the condition are poorly understood. The aim of this study is to discuss a case of LO found amongst the skeletons from the St. Jorgen's leprosarium cemetery (13th-16th/17th centuries), housed in the ADBOU (Anthropological Database of Odense University), Southern Denmark University. A juvenile individual presents a dis- articulated maxillary right central incisor possessing a short root that shows a groove caused by marked constriction beginning approximately 1.5 mm above the neck. From this groove, the diameter decreas- es considerably until the apex. Atrophy of the anterior alveolar maxillary process, extending laterally from the central incisors to the canines, is also apparent. This individual exhibits additional rhinomax- illary lesions (e.g. absorption of the piriform margin including the anterior nasal spine) and foot chang- es (including phalangeal acro-osteolysis) compatible with a diagnosis of lepromatous leprosy. This case contributes to the debate about the significance of this rare condition, particularly in terms of its presence in Scandinavian skeletons from medieval leprosaria cemeteries. Possible interpretations are discussed, including the pathognomonic value of the specific lesion and whether it indicates early childhood onset of leprosy during the Middle Ages. The understanding of LO epidemiology and its relationship with leprosy will benefit from future clinical and skeletal studies.

Pigmented corneal nerves in leprosy patients treated with clofazimine

SUMMARY Clofazimine is a valuable drug for treatment of bacillary infection and for reactional states in leprosy. Side effects include redbrown skin pigmentation, darkening of the skin lesions; red coloration of urine, stools, sputum and sweat; and dryness of the skin and gastro-intestinal symptoms. Conjunctival pigmentation is the most common ocular side effect. Corneal and retinal changes have also been reported. We describe, for the first time, pigmentation of corneal nerves occuring in two patients, with the diagnosis of lepromatous leprosy, treated with clofazimine.

Serological response of patients with leprosy to a 28- to 30-kilodalton protein doublet from early cultures of Mycobacterium bovis BCG.

Analysis by Western immunoblotting of Mycobacterium bovis BCG short-term culture filtrates with a pool of serum samples from lepromatous leprosy patients revealed an immunodominant protein doublet with apparent molecular masses of 28 and 30 kilodaltons (kDa). The humoral response to these antigens was also investigated by using individual serum samples from patients representative of the whole spectrum of leprosy and from tuberculosis patients, as well as from contacts of leprosy patients and control groups. The protein doublet was recognized by 92% of the sera from patients with lepromatous leprosy (51 of 56), whereas essentially negative results were obtained with sera from the other groups. Similar immunodominant bands were also detected by Western blotting analysis of sonic extracts of seven other slow- and fast-growing mycobacterial species, suggesting a broad distribution of these antigens within the genus. Analysis of the purified doublet by Western blotting after two-dimensional gel electrophoresis fractionation showed that the 28- and 30-kDa doublet consisted of at least five different components with pls from 5.2 to 5.7 and molecular masses from 28 to 31 kDa. These results indicate that the protein doublet could be used as a potential marker in the diagnosis of lepromatous leprosy.