1
|
Goswami K, Singh G, Singh A, Trehan S, Kachhadia MP. Cutaneous Anaplastic T-Cell Lymphoma Mimicking a Small Abscess: A Case Report. Cureus 2024; 16:e64455. [PMID: 39135827 PMCID: PMC11318213 DOI: 10.7759/cureus.64455] [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] [Accepted: 07/13/2024] [Indexed: 08/15/2024] Open
Abstract
Non-healing ulcers display a noteworthy demonstrative challenge for clinicians. While often attributed to common causes like infections, these persistent wounds can occasionally mask a more sinister underlying condition: malignancy. This case report presents a 39-year-old Indian man with a non-healing ulcer on his right gluteal region. Despite initial treatments for a presumed bacterial infection, the ulcer persisted. Biopsy ultimately revealed a malignant neoplasm of possible hematopoietic origin, positive for CD30 and focally positive for CD45. Further investigations, including MRI, FNAC, and X-rays, were indicative of lymphoma. Non-healing ulcers present a challenge due to diverse etiologies. A thorough understanding of potential causes, including infectious, vascular, autoimmune, and malignant etiologies, is crucial for navigating the diagnostic process. This case highlights the critical role of maintaining a broad differential diagnosis for non-healing ulcers and the importance of a biopsy in reaching a definitive diagnosis. Early recognition of malignancy in such cases is essential for optimal patient management. This case underscores the importance of considering malignancy in patients with persistent ulcers and performing biopsies for a definitive diagnosis. While the initial presentation mimicked an infectious process, the biopsy revealed a possible cutaneous anaplastic T-cell lymphoma. Further investigations are necessary to definitively classify the specific lymphoma subtype and guide further treatment decisions.
Collapse
Affiliation(s)
- Kanishka Goswami
- Internal Medicine, Maharaj Sawan Singh Charitable Hospital, Beas, IND
| | - Gurjot Singh
- Internal Medicine, Maharaj Sawan Singh Charitable Hospital, Beas, IND
| | - Aishmeet Singh
- Internal Medicine, Maharaj Sawan Singh Charitable Hospital, Beas, IND
| | - Shubam Trehan
- Internal Medicine, Maharaj Sawan Singh Charitable Hospital, Beas, IND
| | | |
Collapse
|
2
|
Udo S, Ogbu Sunday P, Tsaku PA, Oladejo IO, Meka A, Ugwu LC, Ajisola M, Akinyemi J, Oladejo A, Omigbodun A, Choudhury SM, Sartori J, Ilozumba O, Watson S, Lilford R. Raw, Unadulterated African Honey for Ulcer Healing in Leprosy: Protocol for the Honey Experiment on Leprosy Ulcer (HELP) Randomized Controlled Trial. JMIRX MED 2024; 5:e50970. [PMID: 38488451 PMCID: PMC11024902 DOI: 10.2196/50970] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/27/2023] [Accepted: 01/13/2024] [Indexed: 04/20/2024]
Abstract
Background Leprosy leads to nerve damage and slow-healing ulcers, which are treatable with routine therapy. There has been a recent resurgence of interest in the use of honey for the treatment of different kinds of wounds. Objective The aim of this study, Honey Experiment on Leprosy Ulcer (HELP), is to evaluate the healing properties of raw, unadulterated African honey in comparison with normal saline dressing for the treatment leprosy ulcers. Methods This is a multicenter, comparative, prospective, single-blinded, parallel-group, and 1:1 individually randomized controlled trial to be conducted at The Leprosy Referral Hospital, Chanchaga in Minna, Niger State, North Central Nigeria, and St. Benedict Tuberculosis and Leprosy Rehabilitation Hospital in Ogoja, Cross River State, South-South Nigeria. Raw, unadulterated honey will be used in the ulcer dressing of eligible, consenting participants in the intervention group, whereas those in the control group will be treated by dressing with normal saline. The main outcomes will be the proportion of complete healing and the rate of healing up to 84 days after randomization. Follow-up will be conducted 6 months after randomization. We aim to enroll 90-130 participants into the study. Blinded observers will examine photographs of ulcers to determine the outcomes. Results The recruitment of trial participants began on March 14, 2022, and has been continuing for approximately 24 months. Conclusions Our study will provide an unbiased estimate of the effect of honey on the healing of neuropathic ulcers.
Collapse
Affiliation(s)
- Sunday Udo
- The Leprosy Mission Nigeria, Abuja, Nigeria
| | | | | | | | - Anthony Meka
- German Leprosy and TB Relief Association/RedAid Nigeria, Enugu, Nigeria
| | | | | | | | | | | | | | - Jo Sartori
- University of Birmingham, Birmingham, UK
| | | | - Sam Watson
- University of Birmingham, Birmingham, UK
| | | |
Collapse
|
3
|
Rusyati LMM, Saputra H, Indah MS, Setyawati NK. Rare Variant of Leprosy Reaction (Lucio Phenomenon): A Case Series. Int J Mycobacteriol 2024; 13:105-111. [PMID: 38771288 DOI: 10.4103/ijmy.ijmy_184_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 02/12/2024] [Indexed: 05/22/2024] Open
Abstract
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.
Collapse
Affiliation(s)
- Luh Made Mas Rusyati
- Department of Dermatology and Venereology, Prof. Dr. I. G. N. G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Herman Saputra
- Department of Pathology Anatomy, Prof. Dr. I. G. N. G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Made Sanitca Indah
- Department of Dermatology and Venereology, Prof. Dr. I. G. N. G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| | - Ni Kadek Setyawati
- Department of Dermatology and Venereology, Prof. Dr. I. G. N. G. Ngoerah General Hospital, Denpasar, Bali, Indonesia
| |
Collapse
|
4
|
Alcântara SBC, de Araújo JG, Santos DF, da Silva TR, Goulart IMB, Bernardes da Silva AM, Antunes DE. Identification of types of wound bed tissue as a percentage and total wound area by planimetry in neuropathic and venous ulcers. JOURNAL OF VASCULAR NURSING 2023; 41:164-170. [PMID: 38072568 DOI: 10.1016/j.jvn.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 05/13/2023] [Accepted: 06/27/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Neuropathic and venous leg ulcers are chronic wounds associated with devitalized tissue and recurrent infection. Management should be guided by accurate tissue assessment, including the use of planimetry, which provides tissue types as a percentage of the total wound bed surface area. OBJECTIVE This innovative study aimed to assess and identify the wound bed tissues, as a percentage, of neuropathic and venous ulcers using digital planimetry, providing support to nurses optimize the management of necrotic tissues and, consequently, to avoid wound infection. METHODS This cross-sectional study enrolled 24 patients with chronic wounds who were assessed from January to March 2021 at the Wound Outpatients Clinic. The wound photographs were analyzed using Image J 1.53e and a smartphone with WoundDoc Plus® 2.8.2 via digital planimetry. Statistical analyses were performed using the binomial test, t-test, and Mann-Whitney. RESULTS Median wound areas (p=0.3263) did not differ between the group with 2 or 3 risk factors for delayed healing (Md: 31.7) and the group with up to 1 risk factor (Md: 5.3). A low exudate level was associated with the up-to-1-risk-factor-for-delayed-healing group (p=0.0405), while a medium level was associated with the two-or-three-risk-factor group (p=0.0247). A heat map displayed the tissue percentages in the wound bed. In the group with 2 or 3 risk factors for delayed healing, 91.7% (11/12) had less than 70% granulation tissue, which was the primary factor for this group (p<0.0001). Additionally, 66.7% (8/12) of patients with 2 or 3 risk factors for delayed healing exhibited discolored and/or dark red granulation tissue as the primary factor (p=0.0130). CONCLUSION This novel identification of wound area and tissue types as a percentage, using digital planimetry, can play a crucial role in assisting nurses in decision-making related to the appropriate management of devitalized tissues. Furthermore, this measurements may facilitate the conducting of virtual wound consultations and offer valuable support in the development of protocols aimed at preventing infection and biofilm formation in the wound bed.
Collapse
Affiliation(s)
- Silvia Bottaro Carvalho Alcântara
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG 38.413-018, Brazil
| | - Juliano Gonçalves de Araújo
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG 38.413-018, Brazil
| | - Diogo Fernandes Santos
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG 38.413-018, Brazil; School of Medicine, Federal University of Uberlândia, Uberlândia, MG 38400-902, Brazil
| | | | - Isabela Maria Bernardes Goulart
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG 38.413-018, Brazil; Postgraduate Program in Health Sciences, School of Medicine, Federal University of Uberlândia, Uberlândia, MG 38400-902, Brazil
| | | | - Douglas Eulálio Antunes
- National Reference Center for Sanitary Dermatology and Leprosy, Clinics Hospital, Federal University of Uberlândia, Uberlândia, MG 38.413-018, Brazil.
| |
Collapse
|
5
|
Serrano-Coll H, Cardona-Castro N. Neuropathic ulcers in leprosy: clinical features, diagnosis and treatment. J Wound Care 2022; 31:S32-S40. [PMID: 35678776 DOI: 10.12968/jowc.2022.31.sup6.s32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Leprosy is a neglected disease caused by Mycobacterium leprae and Mycobacterium lepromatosis, and is related to significant disabilities resulting from the neural damage generated by this mycobacteria. Neuropathic ulcers-lesions that can appear at the plantar and extra-plantar levels-are one such disability, and diagnosis requires an adequate dermatological, neurological and microbiological evaluation. The treatment of these lesions is based on a multidisciplinary approach that includes debridement of the necrotic tissue, controlling infections, reducing pressure areas, optimising blood flow, and nerve decompression. This review aims to describe the clinical features, diagnostic methods and treatment of neuropathic ulcers in leprosy. The diagnostic methods and medical management used in leprosy ulcers are based on those used for diabetic foot. This requires radical change as these diseases are immunologically and physiologically very different.
Collapse
Affiliation(s)
- Héctor Serrano-Coll
- Research Group in Education and Health Sciences, UNISANGIL-San Gil, Colombia.,Leprosy Research Group, Colombian Institute of Tropical Medicine, CES University, Medellín, Colombia
| | - Nora Cardona-Castro
- Leprosy Research Group, Colombian Institute of Tropical Medicine, CES University, Medellín, Colombia
| |
Collapse
|
6
|
Adya KA, Inamadar AC, Palit A, Shivanna R. Knuckle lesions in inherited and acquired disorders. Indian Dermatol Online J 2021; 12:805-819. [PMID: 34934715 PMCID: PMC8653727 DOI: 10.4103/idoj.idoj_416_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 07/05/2021] [Accepted: 07/29/2021] [Indexed: 11/04/2022] Open
Abstract
Skin lesions occurring over the knuckles can be a primary or characteristic manifestation of a disorder. Characteristic knuckle lesions may also be important cutaneous features of various internal disorders when they serve as useful clinical pointers, as well as may speak of the disease severity in certain instances. Furthermore, knuckle lesions also speak of various external factors as the underlying cause of the disease/lesions, such as trauma - occupational or otherwise, and contact dermatitis. Although knuckles essentially imply dorsal aspect of the metacarpophalangeal joints, many of the lesions described as those 'involving the knuckles' are seen over the proximal and/or less frequently, the distal interphalangel joints as well. This review presents a compilation of various inherited and acquired dermatoses and dermatological manifestations of various internal disorders associated with different forms of knuckle lesions.
Collapse
Affiliation(s)
- Keshavmurthy A Adya
- Department of Dermatology, Venereology and Leprosy, Shri B. M. Patil Medical College, Hospital and Research Center, BLDE (Deemed to be University), Vijayapur, Karnataka, India
| | - Arun C Inamadar
- Department of Dermatology, Venereology and Leprosy, Shri B. M. Patil Medical College, Hospital and Research Center, BLDE (Deemed to be University), Vijayapur, Karnataka, India
| | - Aparna Palit
- Department of Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Kalyani, West Bengal, India
| | - Ragunatha Shivanna
- Department of Dermatology, Venereology and Leprosy, ESIC Medical College and PGIMSR, Rajaji Nagar, Bengaluru, Karnataka, India
| |
Collapse
|
7
|
Chen X, Zha S, Shui TJ. Presenting symptoms of leprosy at diagnosis: Clinical evidence from a cross-sectional, population-based study. PLoS Negl Trop Dis 2021; 15:e0009913. [PMID: 34813585 PMCID: PMC8610243 DOI: 10.1371/journal.pntd.0009913] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/14/2021] [Indexed: 12/31/2022] Open
Abstract
Background Leprosy is associated with different dermatologic and neurologic manifestations within a wide clinical spectrum, causing a great diagnostic challenge. Therefore, we aimed to examine associations between common presenting symptoms of leprosy and stage at diagnosis. Methodology/Principal findings In this cross-sectional study, we analyzed population-level data from the Leprosy Management Information System (LEPMIS) in Yunnan, China, from 2010–2020 and enrolled patients with newly detected leprosy. The data of 2125 newly detected leprosy patients, with 5000 symptoms, were analyzed. Numbness (828/5000, 16.56%), erythema (802/5000, 16.04%), Painless nor pruritic skin lesions (651/5000, 13.02%), eyebrow hair loss (467/5000, 9.34%), and tubercles (442/5000, 8.84%) were common symptoms of leprosy. The symptoms related to skin (1935/2533, 76.39%) and leprosy reaction (279/297, 93.94%) were mainly existed in MB group. While the symptoms related to disability (263/316, 83.49%), clinical feature (38/56, 69.09%), and facial features (19/23, 82.61%) were predominantly presented in delayed diagnostic group. Despite low proportions, formic sensation (99/5000, 1.98%), pain (92/5000, 1.84%), pruritus (56/5000, 1.12%), finger contracture (109/5000, 2.18%), muscle atrophy (71/5000, 1.42%), and motor dysfunction (18/5000, 0.36%) were reported during the diagnosis of leprosy. The proportions of skin, skin and nerve, and nerve symptoms as initial symptoms were 33.25%, 44.95%, and 21.80% and as only symptoms were 28.66%, 57.81%, and 13.91%, respectively. In those with physical disability, nerve symptoms were the most frequent symptoms (57.65% and 65.36% for the initial and only symptoms, respectively) compared with skin and skin and nerve symptoms. In the delayed diagnosis group, nerve symptoms were the most frequent symptoms (15.73% and 17.25%) and were associated with the longest diagnostic intervals (mean±SD: 38.88±46.02 and 40.35±49.36 months for initial and only symptoms, respectively) when compared with skin and skin and nerve symptoms. Conclusions Understanding the nature of presenting symptoms and developing symptom awareness campaigns would improve the level of leprosy awareness in the community. As nerve symptoms were related to a higher proportion of physical disability and longer diagnosis interval, we should increase awareness about nerve symptoms. Individuals with nerve symptoms should be considered the target group. Neurology outpatient visits may provide potential screening opportunities, and holding focused training for specialized neurology medical staff would enhance the capacity of the health system to recognize leprosy early. Early diagnosis is key in leprosy control; however, the diagnosis of leprosy is still challenging. In this study, we reviewed the common and rare symptoms of leprosy. Numbness, erythema, painless nor pruritic skin lesions, eyebrow hair loss, and tubercles were common symptoms of leprosy. Despite low proportions, formic sensation, pain, pruritus, finger contracture, muscle atrophy, and motor dysfunction were also reported by leprosy patients. As initial symptoms at symptom onset and only symptoms at diagnosis, nerve symptoms were associated with a greater degree of physical disability and a longer diagnosis interval than skin and skin and nerve symptoms. Understanding the presenting symptoms in detail would improve the level of leprosy awareness in the community. Increasing awareness of nerve symptoms, focusing on individuals with nerve symptoms at neurology outpatient visits, and holding focused training for medical staff specializing in neurology would enhance the capacity of the health system to recognize leprosy early.
Collapse
Affiliation(s)
- Xiaohua Chen
- Beijing Tropical Medicine Research Institute, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory for Research on Prevention and Treatment of Tropical Diseases, Capital Medical University, Beijing, China
| | - Shun Zha
- Yunnan Center for Disease Control and Prevention, Yunnan, China
| | - Tie-Jun Shui
- Yunnan Center for Disease Control and Prevention, Yunnan, China
- * E-mail:
| |
Collapse
|
8
|
LoRusso S. Infections of the Peripheral Nervous System. Continuum (Minneap Minn) 2021; 27:921-942. [PMID: 34623098 DOI: 10.1212/con.0000000000000981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article describes infections that affect the peripheral nervous system, including their clinical features, differential diagnoses, and treatments. RECENT FINDINGS Rates of pyomyositis have increased recently in the United States, possibly because of an increase in risk factors such as IV drug use, obesity, and diabetes. Other peripheral nervous system infections, such as diphtheria, have become more common in older patients secondary to a lack of revaccination or waning immunity. Although recommended treatment regimens for most infections remain unchanged over recent years, debate over the ideal dosing and route of administration continues for some infections such as tetanus and leprosy (Hansen disease). SUMMARY Infections of the peripheral nervous system are varied in terms of the type of infection, localization, and potential treatment. Nerve conduction studies and EMG can help determine localization, which is key to determining an initial differential diagnosis. It is important to recognize infections quickly to minimize diagnostic delays that could lead to patient morbidity and mortality.
Collapse
|
9
|
Shukla P, Malhotra KP, Verma P, Suvirya S, Saraswat A, Jain A. Unusual non-trophic ulcerations in leprosy: A case series of 17 patients. Trop Doct 2021; 51:542-552. [PMID: 33722150 DOI: 10.1177/0049475521998499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Non-neuropathic ulcers in leprosy patients are infrequently seen, and atypical presentations are prone to misdiagnosis. We evaluated diagnosed cases of leprosy between January 2017 and January 2020 for the presence of cutaneous ulceration, Ridley-Jopling subtype of leprosy, reactions and histologic features of these ulcerations. Treatment was given as WHO recommended multi-bacillary multi-drug therapy. We found 17/386 leprosy patients with non-neuropathic ulcers. We describe three causes - spontaneous cutaneous ulceration in lepromatous leprosy (one nodular and one diffuse), lepra reactions (five patients with type 1; nine with type 2, further categorised into ulcerated Sweet syndrome-like who also had pseudoepitheliomatous hyperplasia, pustulo-necrotic and necrotic erythema nodosum leprosum) and Lucio phenomenon (one patient). Our series draws attention towards the different faces of non-neuropathic ulcers in leprosy, including some atypical and novel presentations.
Collapse
Affiliation(s)
- Prakriti Shukla
- Senior Resident, Department of Dermatology, Venereology & Leprosy, King George's Medical University, Lucknow, India
| | - Kiran Preet Malhotra
- Additional Professor, Department of Pathology, 233619Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - Parul Verma
- Associate Professor, Department of Dermatology, Venereology & Leprosy, King George's Medical University, Lucknow, India
| | - Swastika Suvirya
- Additional Professor, Department of Dermatology, Venereology & Leprosy, King George's Medical University, Lucknow, India
| | - Abir Saraswat
- Consultant Dermatologist, Indushree Skin Clinic, Lucknow, India
| | - Amita Jain
- Professor, Department of Microbiology, 76140King George's Medical University, Lucknow, India
| |
Collapse
|