1
|
Cruz VA, de Albuquerque CP, Guimarães MFBDR, Dionello CDF, Ribeiro SLE, de Souza VA, Gomes CM, da Mota LMH. New insights at the interface between leprosy and immune-mediated rheumatic diseases. Front Med (Lausanne) 2023; 10:1239775. [PMID: 37822467 PMCID: PMC10564075 DOI: 10.3389/fmed.2023.1239775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/23/2023] [Indexed: 10/13/2023] Open
Abstract
Leprosy is an infectious and contagious disease of slow evolution, triggered by Mycobacterium leprae. Arthritis is its third most common manifestation, after cutaneous and peripheral nerve involvement. Since musculoskeletal symptoms may be the initial presentation of the disease, it is important for health professionals to recognize its rheumatic manifestations for early diagnosis and appropriate treatment, especially in endemic areas. In addition, cases of leprosy have increased globally, notably in patients undergoing treatment with TNF-α blockers and due to the increase in migration and travel of people from developing countries to developed countries. This review proposes to discuss the main scenarios of mimicry of different rheumatic diseases by leprosy, as well as the role of immunosuppressive drugs used in rheumatology practice in the treatment of reactional states and in the risk of developing the infection.
Collapse
|
2
|
Leprosy: A Review of Epidemiology, Clinical Diagnosis, and Management. J Trop Med 2022; 2022:8652062. [PMID: 35832335 PMCID: PMC9273393 DOI: 10.1155/2022/8652062] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/20/2022] [Accepted: 06/22/2022] [Indexed: 01/03/2023] Open
Abstract
Leprosy is a neglected infectious disease caused by acid-fast bacillus Mycobacterium leprae. It primarily affects the skin and then progresses to a secondary stage, causing peripheral neuropathy with potential long-term disability along with stigma. Leprosy patients account for a significant proportion of the global disease burden. Previous efforts to improve diagnostic and therapeutic techniques have focused on leprosy in adults, whereas childhood leprosy has been relatively neglected. This review aims to update the diagnostic and therapeutic recommendations for adult and childhood leprosy. This review summarizes the clinical, bacteriological, and immunological approaches used in the diagnosis of leprosy. As strategies for the diagnosis and management of leprosy continue to develop better and more advanced knowledge, control and prevention of leprosy are crucial.
Collapse
|
3
|
Gupta S, Li C, Thallapally VK, Sharma P, Nahas J. Chronic Hand Swelling and Dactylitis in Leprosy: A Case Report and Review of the Literature. Cureus 2021; 13:e13451. [PMID: 33767935 PMCID: PMC7983738 DOI: 10.7759/cureus.13451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Leprosy is an infectious disease that is associated with various types of presentations. Diagnosis of the disease can be tricky in cases of atypical presentations. We report a unique case of leprosy characterized by chronic hand swelling, dactylitis, and seropositive laboratory markers, which was diagnosed in a rheumatology clinic.
Collapse
Affiliation(s)
- Sonia Gupta
- Internal Medicine, Creighton University, Omaha, USA
| | | | | | | | | |
Collapse
|
4
|
Dorilêo GB, Cavalcante LRDS, Lopes JC, Damazo AS. Report of two cases of lepromatous leprosy at an early age. Int J Infect Dis 2020; 101:46-48. [PMID: 32992010 DOI: 10.1016/j.ijid.2020.09.1448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 11/30/2022] Open
Abstract
Leprosy is an infectious disease that has a broad spectrum of clinical manifestations. Lepromatous leprosy has a deficient cellular immune response and high bacillary multiplication. It has epidemiological importance, as it is the most contagious clinical form of the disease. Its manifestation in children and adolescents is unusual. In the present study, we report two cases of leprosy at an early age, manifesting the lepromatous clinical form, highlighting the auricular involvement in one case. Early diagnosis is an essential tool to avoid deformities and deficiencies.
Collapse
Affiliation(s)
| | - Leticia Rossetto da Silva Cavalcante
- Post-Graduate Program in Professional Master in Applied Science at Hospital Atention, University Hospital Julio Müller, Cuiabá, MT, Brazil; Ambulatory of Leprosy, University Hospital Julio Müller, Cuiabá, MT, Brazil
| | - José Cabral Lopes
- Ambulatory of Leprosy, University Hospital Julio Müller, Cuiabá, MT, Brazil
| | - Amilcar Sabino Damazo
- Post-Graduate Program in Professional Master in Applied Science at Hospital Atention, University Hospital Julio Müller, Cuiabá, MT, Brazil; Department of Basic Sciences in Health, Faculty of Medicine, Federal University of Mato Grosso, Cuiabá, MT, 78060-900, Brazil.
| |
Collapse
|
5
|
Queiroz LB, Lourenço B, Silva LEV, Lourenço DMR, Silva CA. Musculoskeletal pain and musculoskeletal syndromes in adolescents are related to electronic devices. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
6
|
Queiroz LB, Lourenço B, Silva LEV, Lourenço DMR, Silva CA. Musculoskeletal pain and musculoskeletal syndromes in adolescents are related to electronic devices. J Pediatr (Rio J) 2018; 94:673-679. [PMID: 29172038 DOI: 10.1016/j.jped.2017.09.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 09/08/2017] [Accepted: 09/27/2017] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To evaluate television and simultaneous electronic devices use in adolescents with musculoskeletal pain and musculoskeletal pain syndromes. METHODS A cross-sectional study was performed in 299 healthy adolescents of a private school. All students completed a self-administered questionnaire, including: demographic data, physical activities, musculoskeletal pain symptoms, and use of simultaneous television/electronic devices (computer, internet, electronic games, and cell phones). Seven musculoskeletal pain syndromes were also evaluated: juvenile fibromyalgia, benign joint hypermobility syndrome, myofascial syndrome, tendinitis, bursitis, epicondylitis, and complex regional pain syndrome. RESULTS Inter-rater agreement between pretest and retest was 0.83. Musculoskeletal pain and musculoskeletal pain syndrome were found in 183/299 (61%) and 60/183 (33%), respectively. The median age (15 [10-18] vs. 14 [10-18] years, p=0.032) and years of education (10 [5-12] vs. 9 [5-12] years, p=0.011) were significantly higher in adolescents with musculoskeletal pain when compared with those without this condition. The frequencies of female gender (59% vs. 47%, p=0.019), cell phone use (93% vs. 81%, p=0.003), and simultaneous use of at least two electronic devices (80% vs. 67%, p=0.011) were significantly higher in the former group. Further comparisons between adolescents with and without musculoskeletal pain syndromes revealed that the frequency of female gender was significantly higher in the former group (75% vs. 25%, p=0.002), and with a significantly reduced median of weekends/holidays electronic games use (1.5 [0-10] vs. 3 [0-17]h/day, p=0.006). CONCLUSIONS A high prevalence of musculoskeletal pain/syndromes was observed in female adolescents. Musculoskeletal pain was mostly reported at a median age of 15 years, and students used at least two electronic devices. Reduced use of electronic games was associated with musculoskeletal pain syndromes.
Collapse
Affiliation(s)
- Lígia Bruni Queiroz
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Unidade Adolescente, São Paulo, SP, Brazil.
| | - Benito Lourenço
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Unidade Adolescente, São Paulo, SP, Brazil
| | - Luiz Eduardo Vargas Silva
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, Unidade Adolescente, São Paulo, SP, Brazil
| | | | - Clovis Artur Silva
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, São Paulo, SP, Brazil
| |
Collapse
|
7
|
Alveno RA, Miranda CV, Passone CG, Waetge AR, Hojo ES, Farhat SCL, Odone-Filho V, Tannuri U, Carvalho WB, Carneiro-Sampaio M, Silva CA. Pediatric chronic patients at outpatient clinics: a study in a Latin American University Hospital. J Pediatr (Rio J) 2018; 94:539-545. [PMID: 28982637 DOI: 10.1016/j.jped.2017.07.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 06/24/2017] [Accepted: 07/05/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To describe the characteristics of children and adolescentes with chronic diseases of outpatient clinics at a tertiary university hospital. METHODS A cross-sectional study was performed with 16,237 patients with chronic diseases followed-up in one year. The data were collected through the electronic system, according to the number of physician appointments in 23 pediatric specialties. Patients were divided in two groups: children (0-9 years) and adolescents (10-19 years). Early (10-14 years) and late (15-19 years) adolescent groups were also analyzed. RESULTS Of the total sample, 56% were children and 46% were adolescents. The frequencies of following pediatric specialties were significantly higher in adolescents when compared with children: cardiology, endocrinology, hematology, nephrology/renal transplantation, neurology, nutrology, oncology, palliative and pain care, psychiatry, and rheumatology (p<0.05). The frequencies of emergency service visits (30% vs. 17%, p<0.001), hospitalizations (23% vs. 11%, p<0.001), intensive care unit admissions (6% vs. 2%, p<0.001), and deaths (1% vs. 0.6%, p=0.002) were significantly lower in adolescents than in children. However, the number of physician appointments (≥13) per patient was also higher in the adolescent group (5% vs. 6%, p=0.018). Further analysis comparison between early and late adolescents revealed that the first group had significantly more physician appointments (35% vs. 32%, p=0.025), and required more than two pediatric specialties (22% vs. 21%, p=0.047). Likewise, the frequencies of emergency service visits (19% vs. 14%, p<0.001) and hospitalizations (12% vs. 10%, p=0.035) were higher in early adolescents. CONCLUSIONS This study evaluated a large population in a Latin American hospital and suggested that early adolescents with chronic diseases required many appointments, multiple specialties and hospital admissions.
Collapse
Affiliation(s)
- Renata A Alveno
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Departamento de Pediatria, São Paulo, SP, Brazil
| | - Caroline V Miranda
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Departamento de Pediatria, São Paulo, SP, Brazil
| | - Caroline G Passone
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Departamento de Pediatria, São Paulo, SP, Brazil
| | - Aurora R Waetge
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, São Paulo, SP, Brazil
| | - Elza S Hojo
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, São Paulo, SP, Brazil
| | - Sylvia C L Farhat
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, São Paulo, SP, Brazil
| | - Vicente Odone-Filho
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Departamento de Pediatria, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, São Paulo, SP, Brazil
| | - Uenis Tannuri
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Departamento de Pediatria, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, São Paulo, SP, Brazil
| | - Werther B Carvalho
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Departamento de Pediatria, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, São Paulo, SP, Brazil
| | - Magda Carneiro-Sampaio
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Departamento de Pediatria, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, São Paulo, SP, Brazil
| | - Clovis A Silva
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Departamento de Pediatria, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, São Paulo, SP, Brazil.
| |
Collapse
|
8
|
Alveno RA, Miranda CV, Passone CG, Waetge AR, Hojo ES, Farhat SC, Odone‐Filho V, Tannuri U, Carvalho WB, Carneiro‐Sampaio M, Silva CA. Pediatric chronic patients at outpatient clinics: a study in a Latin American University Hospital. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
9
|
Ramos JM, Ortiz-Martínez S, Lemma D, Petros MM, Ortiz-Martínez C, Tesfamariam A, Reyes F, Belinchón I. Epidemiological and Clinical Characteristics of Children and Adolescents with Leprosy Admitted Over 16 Years at a Rural Hospital in Ethiopia: A Retrospective Analysis. J Trop Pediatr 2018. [PMID: 28645166 DOI: 10.1093/tropej/fmx048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
AIM To analyse differences in children and adolescents aged ≤18 years admitted to the leprosy ward in a rural Ethiopian hospital >16 years. METHODS We retrospectively collected data from leprosy admission registry books on patients with leprosy who were admitted to a referral hospital from September 2000 to September 2016. RESULTS There were 2129 admissions for leprosy during the study period: 180 (8.4%) patients were s ≤ 18 years old. Of these, 98 (54.4%) were male and 82 (45.6%) were female. The proportion of new diagnoses in children and adolescents was 31.7%, significantly higher than in adults (11.7%; p < 0.001). There were also significant differences in the prevalence of lepromatous ulcers (46.9 vs. 61.7%), leprosy reaction (29.4 vs. 13.0%) and neuritis (16.9 vs.5.3%) between these age groups. CONCLUSIONS There were more new diagnoses, leprosy reactions and neuritis, and fewer lepromatous ulcers, in children and adolescents compared with adults, with younger patients being referred more frequently to reference centres.
Collapse
Affiliation(s)
- José M Ramos
- Department of Paediatrics and Medicine, Gambo Rural General Hospital, Shashemane, Ethiopia.,Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante 03010, Spain.,Department of Medicine, Miguel Hernández University of Elche, San Joan d'Alacant, Alicante 03550, Spain
| | - Sonia Ortiz-Martínez
- Department of Paediatrics and Medicine, Gambo Rural General Hospital, Shashemane, Ethiopia.,Primary Care Unit, El Bonillo Centro de Salud, Albacete 02610, Spain
| | - Deriba Lemma
- Department of Paediatrics and Medicine, Gambo Rural General Hospital, Shashemane, Ethiopia
| | - Matheus M Petros
- Department of Paediatrics and Medicine, Gambo Rural General Hospital, Shashemane, Ethiopia
| | - Carmen Ortiz-Martínez
- Palliative Care Unit, Hospital Nuestra Señora del Perpetuo Socorro, Albacete 02006, Spain
| | - Abraham Tesfamariam
- Department of Paediatrics and Medicine, Gambo Rural General Hospital, Shashemane, Ethiopia
| | - Francisco Reyes
- Department of Paediatrics and Medicine, Gambo Rural General Hospital, Shashemane, Ethiopia
| | - Isabel Belinchón
- Department of Medicine, Miguel Hernández University of Elche, San Joan d'Alacant, Alicante 03550, Spain.,Service of Dermatology, Hospital General Universitario de Alicante, Alicante 03010, Spain
| |
Collapse
|
10
|
Muratt G, Rosa E, Willers T, Lopes M, Toruinho T. DIAGNÓSTICO DIFERENCIAL INCOMUM DE ARTRALGIA. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
11
|
Maia MM, Gualano B, Sá-Pinto AL, Sallum AM, Pereira RM, Len CA, Terreri MT, Barbosa CM, Roschel H, Silva CA. Juvenile fibromyalgia syndrome: Blunted heart rate response and cardiac autonomic dysfunction at diagnosis. Semin Arthritis Rheum 2016; 46:338-343. [DOI: 10.1016/j.semarthrit.2016.07.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/28/2016] [Accepted: 07/14/2016] [Indexed: 11/26/2022]
|
12
|
|
13
|
de Oliveira MBB, Diniz LM. Leprosy among children under 15 years of age: literature review. An Bras Dermatol 2016; 91:196-203. [PMID: 27192519 PMCID: PMC4861567 DOI: 10.1590/abd1806-4841.20163661] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 09/16/2014] [Indexed: 11/25/2022] Open
Abstract
Leprosy is a chronic infectious disease caused by Mycobacterium leprae, representing a public health issue in some countries. Though more prevalent in adults, the detection of new cases in children under 15 years of age reveals an active circulation of bacillus, continued transmission and lack of disease control by the health system, as well as aiding in the monitoring of the endemic. Among patients under 15 years of age, the most affected age group is children between 10 and 14 years of age, although cases of patients of younger than 1 year of age have also been reported. Household contacts are the primary source of infection, given that caretakers, such as babysitters and others, must be considered in this scenario. Paucibacillary forms of the disease prevailed, especially borderline-tuberculoid leprosy, with a single lesion in exposed areas of the body representing the main clinical manifestation. Reactional states: Lepra reactions are rare, although some authors have reported high frequencies of this phenomenon, the most frequent of which is Type 1 Lepra Reaction. Peripheral nerve involvement has been described at alarming rates in some studies, which increases the chance of deformities, a serious problem, especially if one considers the age of these patients. The protective effect of BCG vaccination was found in some studies, but no consensus has been reached among different authors. Children must receive the same multidrug therapy regimen and the doses should, ideally, be calculated based on the child´s weight. Adverse reactions to this therapy are rare within this age group. This article aims to review epidemiological, clinical, and therapeutic aspects of leprosy in patients under 15 years of age.
Collapse
|
14
|
Neder L, van Weelden M, Viola GR, Lourenço DM, Len CA, Silva CA. Health-related quality of life evaluated by Pediatric Quality of Life Inventory 4.0 in pediatric leprosy patients with musculoskeletal manifestations. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 55:414-9. [PMID: 26144576 DOI: 10.1016/j.rbr.2014.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 10/23/2014] [Accepted: 12/01/2014] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the health-related quality of life (HRQL) in pediatric leprosy patients. METHODS A cross-sectional study included 47 leprosy patients and 45 healthy subjects. The HRQL was measured by Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0), and evaluated physical, emotional, social and school domains. The leprosy patients were classified by Ridley and Jopling classification criteria and assessed according to clinical musculoskeletal manifestations, laboratory and radiographic examinations. RESULTS The median of current age was similar in leprosy patients and controls [12(6-18) vs. 15(5-18)years, p = 0.384], likewise the frequencies of female gender (p = 0.835) and middle/lower Brazilian socio-economic classes (p = 1.0). The domain school activities according the child-self report was significantly lower in leprosy patients compared to controls in the age group of 13-18 years [75(45-100) vs. 90(45-100), p = 0.021]. The other domains were alike in both groups (p > 0.05). At least one musculoskeletal manifestation (arthralgia, arthritis and/or myalgia) was observed in 15% of leprosy patients and none in controls (p = 0.012). Further comparison between all leprosy patients showed that the median of the physical capacity domain [81.25(50-100) vs. 98.44(50-100), p = 0.036] and school activities domain by child-self report [60(50-85) vs. 80(45-100), p = 0.042] were significantly lower in patients with musculoskeletal manifestations compared to patients without these manifestations. No differences were evidenced between the other HRQL parameters in both groups, reported by patients and parents (p > 0.05). CONCLUSIONS Reduced physical capacity and school activities domains were observed in pediatric leprosy patients with musculoskeletal manifestations.
Collapse
Affiliation(s)
- Luciana Neder
- Serviço de Dermatologia, Universidade Federal do Mato Grosso (UFMT), Cuiabá, MT, Brasil
| | - Marlon van Weelden
- VU University, Faculdade de Medicina, Amsterdã, Holanda; Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brasil
| | - Gabriela Ribeiro Viola
- Unidade de Reumatologia Pediátrica, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brasil
| | - Daniela Mencaroni Lourenço
- Unidade de Reumatologia Pediátrica, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brasil
| | - Claudio A Len
- Unidade de Reumatologia Pediátrica, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Clovis A Silva
- Unidade de Reumatologia Pediátrica, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brasil; Divisão de Reumatologia, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brasil.
| |
Collapse
|
15
|
Balachandar G, Reddy MN. Compressive Ulnar Neuropathy Due to a Ganglion Cyst and Thickened Cubital Tunnel Retinaculum Fifty Years After Osteomyelitis Variolosa of the Elbow: A Case Report. JBJS Case Connect 2015; 5:e67. [PMID: 29252854 DOI: 10.2106/jbjs.cc.n.00194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE Ulnar neuropathy developed acutely in a fifty-four-year-old man with an arthritic and deformed elbow as the result of osteomyelitis variolosa, a complication of smallpox, which he contracted at the age of five years. Intraoperatively, a ganglion cyst arising from the joint and a pathologically thick cubital tunnel retinaculum were found to be compressing the nerve. Surgical excision of the ganglion, release of the cubital tunnel retinaculum, and anterior transposition of the ulnar nerve resulted in substantial clinical improvement at one year. CONCLUSION The deformity and limited motion that can develop in the elbow over time following osteomyelitis variolosa may predispose the patient to ulnar neuropathy caused by a ganglion cyst arising in the compromised cubital tunnel.
Collapse
Affiliation(s)
- Gopalan Balachandar
- Department of Orthopedics, Chettinad Hospital and Research Institute, Rajiv Gandhi Salai (OMR, Chennai), Kelambakkam, Kancheepuram District, Tamil Nadu, 603 103, India. .
| | | |
Collapse
|
16
|
Lopes VAP, Lourenço DMR, Guariento A, Trindade MA, Avancini J, Silva CA. Borderline tuberculoid leprosy in childhood onset systemic lupus erythematosus patient. Lupus 2015; 24:1448-51. [DOI: 10.1177/0961203315593167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 06/03/2015] [Indexed: 11/16/2022]
Abstract
Leprosy is a contagious and chronic systemic granulomatous disease caused by the bacillus Mycobacterium leprae. To our knowledge, no case of leprosy in a childhood-onset systemic lupus erythematosus (c-SLE) patient has been reported. For a period of 31 years, 312 c-SLE patients were followed at the Pediatric Rheumatology Unit of our University Hospital. One of them (0.3%) had tuberculoid leprosy skin lesions during the disease course and is here reported. A 10-year-old boy from Northwest of Brazil was diagnosed with c-SLE based on malar rash, photosensitivity, oral ulcers, lymphopenia, proteinuria, positive antinuclear antibodies, anti-double-stranded DNA, anti-Sm and anti-Ro/SSA autoantibodies. He was treated with prednisone, hydroxychloroquine and intravenous cyclophosphamide, followed by mycophenolate mofetil. At 12-years-old, he presented asymmetric skin lesions characterized by erythematous plaques with elevated external borders and hypochromic center with sensory loss. Peripheral nerve involvement was not evidenced. No history of familial cases of leprosy was reported, although the region where the patient resides is considered to be endemic for leprosy. Skin biopsy revealed a well-defined tuberculoid form. A marked thickening of nerves was observed, often destroyed by granulomas, without evidence of Mycobacterium leprae bacilli. At that time, the SLEDAI-2K score was 4 and he had been receiving prednisone 15 mg/day, hydroxychloroquine 200 mg/day and mycophenolate mofetil 3 g/day. Paucibacillary treatment for leprosy with dapsone and rifampicine was also introduced. In conclusion, we have reported a rare case of leprosy in the course of c-SLE. Leprosy should always be considered in children and adolescents with lupus who present skin abnormalities, particularly with hypoesthesic or anesthesic cutaneous lesions.
Collapse
Affiliation(s)
- V A P Lopes
- Centro Universitário de Saúde, Ciências Humanas e Tecnologia do Piauí UNINOVAFAPI, Teresina, Brazil
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo (FMUSP), São Paulo, Brazil
| | - D M R Lourenço
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo (FMUSP), São Paulo, Brazil
| | - A Guariento
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo (FMUSP), São Paulo, Brazil
- Pediatric Rheumatology Unit, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - M A Trindade
- Dermatology Department, FMUSP, São Paulo, Brazil
| | - J Avancini
- Dermatology Department, FMUSP, São Paulo, Brazil
| | - C A Silva
- Pediatric Rheumatology Unit, Faculdade de Medicina da Universidade São Paulo (FMUSP), São Paulo, Brazil
| |
Collapse
|
17
|
Fahl K, Silva CA, Pastorino AC, Carneiro-Sampaio M, Jacob CMA. [Autoimmune diseases and autoantibodies in pediatric patients and their first-degree relatives with immunoglobulin A deficiency]. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 55:197-202. [PMID: 25582995 DOI: 10.1016/j.rbr.2014.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 08/01/2014] [Accepted: 10/06/2014] [Indexed: 10/24/2022] Open
Abstract
INTRODUCTION Clinical manifestations of Immunoglobulin A Deficiency (IgAD) include recurrent infections, atopy and autoimmune diseases. However, to our knowledge, the concomitant evaluations of autoimmune diseases and autoantibodies in a cohort of IgAD patients with current age > 10 years-old and their relatives have not been assessed. OBJECTIVES To evaluate autoimmune diseases and the presence of autoantibodies in IgAD patients and their first-degree relatives. METHODS A cross-sectional study was performed in 34 IgAD patients (current age > 10 years-old) and their first-degree relatives. All of them were followed at a tertiary Brazilian primary immunodeficiency center: 27 children/adolescents and 7 of their first-degree relatives with a late diagnosis of IgAD. Autoimmune diseases and autoantibodies (antinuclear antibodies, rheumatoid factor, and anti-thyroglobulin, anti-thyroperoxidase and IgA class anti-endomysial antibodies) were also assessed. RESULTS Autoimmune diseases (n=14) and/or autoantibodies (n=10, four of them with isolated autoantibodies) were observed in 18/34 (53%) of the patients and their relatives. The most common autoimmune diseases found were thyroiditis (18%), chronic arthritis (12%) and celiac disease (6%). The most frequent autoantibodies were antinuclear antibodies (2%), anti-thyroglobulin and/or anti-thyroperoxidase (24%). No significant differences were observed in the female gender, age at diagnosis and current age in IgAD patients with and without autoimmune diseases and/or presence of autoantibodies (p>0.05). The frequencies of primary immunodeficiency's in family, autoimmunity in family, atopy and recurrent infections were similar in both groups (p>0.05). CONCLUSION Autoimmune diseases and autoantibodies were observed in IgAD patients during follow-up, reinforcing the necessity of a rigorous and continuous follow-up during adolescence and adulthood.
Collapse
Affiliation(s)
- Kristine Fahl
- Unidade de Alergia Pediátrica e Imunologia, Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Clovis A Silva
- Unidade de Reumatologia Pediátrica, Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil; Divisão de Reumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Antonio C Pastorino
- Unidade de Alergia Pediátrica e Imunologia, Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Magda Carneiro-Sampaio
- Unidade de Alergia Pediátrica e Imunologia, Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - Cristina M A Jacob
- Unidade de Alergia Pediátrica e Imunologia, Departamento de Pediatria, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
| |
Collapse
|
18
|
Rheumatic and other musculoskeletal manifestations and autoantibodies in childhood and adolescent leprosy: significance and relevance. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2014. [DOI: 10.1016/j.jpedp.2014.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
19
|
Chopra A. Rheumatic and other musculoskeletal manifestations and autoantibodies in childhood and adolescent leprosy: significance and relevance. J Pediatr (Rio J) 2014; 90:431-6. [PMID: 24973468 DOI: 10.1016/j.jped.2014.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 06/17/2014] [Indexed: 11/28/2022] Open
|