Leprosy: new insight into an ancient disease

Dos casos de lepra en Valladolid

Leprosy is still a major health problem on a worldwide level, and although it does not reach endemic levels on our continent, it seems that there is an upward trend due to the number of imported cases diagnosed each year. We present two cases of lepromatous leprosy diagnosed in Valladolid within a five-month period. The last reported case of this disease in our community was over 20 years ago.

Schwannomatosis: a clinical and pathologic study

Schwannomas are benign nerve sheath tumors that most commonly occur singularly in otherwise normal individuals. Multiple schwannomas in a single patient are most often seen in neurofibromatosis 2 (NF2), but several recent reports suggest that schwannomatosis may also be a distinct clinical entity. We studied the clinical, radiographic, and pathologic features of 14 patients with multiple schwannomas who did not have vestibular schwannoma diagnostic of NF2. Most patients had peripheral nerve tumors that presented with pain. Many also had spinal nerve root and cranial nerve tumors. Three had multiple tumors limited to a single limb. We found that these 14 individuals did not exhibit phenotypic overlap with the neurofibromatoses. Only 1 of 14 patients had a positive family history. We conclude that patients with multiple schwannomas, who do not have vestibular schwannoma, comprise a distinct clinical problem, but further molecular genetic analysis is needed to define the pathophysiology of this disorder.

Cutaneous-malignancy and leprosy. Report of a patient with Mycobacterium leprae and basal cell carcinoma concurrently present in the same lesion

BACKGROUND

Leprosy is a chronic systemic infection caused by the bacillus Mycobacterium leprae. Cutaneous neoplasms have been observed in patients with leprosy. Also, albeit less commonly, M. leprae have been documented in the lesions of skin cancer.

OBJECTIVE

To describe a 62-year-old man with chronic sun exposure and exposure to armadillos who subsequently developed lepromatous leprosy, to discuss the cutaneous malignancies that have occurred in patients with leprosy, and to review the literature concerning the concurrent presence of an infectious pathogen and a cutaneous neoplasm in the same lesion.

METHODS

Our patient's basal cell carcinomas were excised, his abdominal plaques were biopsied, and his leprosy infection was treated with dapsone and rifampin. The types of cutaneous malignancies in leprosy patients and infectious pathogens concurrently found in lesions of skin tumors were summarized after evaluating previously published reports.

RESULTS

Skin biopsies from our patient demonstrated M. leprae bacilli not only in his abdominal plaques, but also in all of his basal cell carcinoma lesions. Fungal, mycobacterial, and viral pathogens have concurrently been observed in skin lesions of basal cell carcinomas, Kaposi's sarcoma, melanoma, mycosis fungoides, and squamous cell carcinoma.

CONCLUSION

Patients with leprosy can develop skin cancers and the histologic interpretation of those skin cancers can show evidence of leprosy. It is uncertain to what degree the decreased cell-mediated immunity in patients with lepromatous leprosy either enhances their susceptibility to and/or influences the course of their cutaneous neoplasms; also, in these patients, the coexistence of M. leprae organisms and cutaneous malignancy in the same lesion is likely to be secondary to the high bacillary load that is present.

Immune regulation: learning from leprosy

The specific anergy seen in severe, disseminated leprosy appears to represent multifaceted actions of macrophages and suppressor T lymphocytes. Identification of cytokine mediation in these events helps to account for the immune system's "choice" of cellular versus humoral defenses--and points toward manipulation of cytokine switches for immunotherapy against infectious and autoimmune disease.

Lepromatous leprosy: nasal manifestations and treatment with minocycline

Nasal involvement in lepromatous leprosy is universal and occurs early in the course of the disease. Nasal symptoms include obstruction, crusting, bleeding, and hyposmia. Traditional therapy with dapsone, rifampin, and clofazimine is limited by its cost and toxicity. Minocycline hydrochloride, a tetracycline antibiotic with limited side effects, is promising as a new treatment for leprosy. A case is presented that highlights the clinical presentation, diagnosis, and treatment of lepromatous leprosy.