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Quintarelli L, Magnaterra E, Maglie R, Corrà A, Ruffo di Calabria V, Aimo C, Mariotti EB, Verdelli A, Maio V, Antiga E, Caproni M. Lepromatous leprosy presenting with erythema nodosum leprosum mimicking Bechet's disease. Travel Med Infect Dis 2022; 52:102521. [PMID: 36528249 DOI: 10.1016/j.tmaid.2022.102521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/16/2022]
Affiliation(s)
- L Quintarelli
- Rare Diseases Unit, Azienda USL Toscana Centro, European Reference Network-Skin Member, Department of Health Sciences, University of Florence, Florence, Italy
| | - E Magnaterra
- Department of Health Sciences, Section Dermatology, University of Florence, Italy.
| | - R Maglie
- Department of Health Sciences, Section Dermatology, University of Florence, Italy
| | - A Corrà
- Department of Health Sciences, Section Dermatology, University of Florence, Italy
| | - V Ruffo di Calabria
- Department of Health Sciences, Section Dermatology, University of Florence, Italy
| | - C Aimo
- Department of Health Sciences, Section Dermatology, University of Florence, Italy
| | - E B Mariotti
- Department of Health Sciences, Section Dermatology, University of Florence, Italy
| | - A Verdelli
- Rare Diseases Unit, Azienda USL Toscana Centro, European Reference Network-Skin Member, Department of Health Sciences, University of Florence, Florence, Italy
| | - V Maio
- Department of Health Sciences, University of Florence, Florence, Italy
| | - E Antiga
- Department of Health Sciences, Section Dermatology, University of Florence, Italy
| | - M Caproni
- Department of Health Sciences, University of Florence, Florence, Italy
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2
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Stankiewicz Karita HC, Stankiewicz Acosta C, Simmons JD. A Young Woman With Ulcerated Skin Lesions on Her Lower Extremities. Clin Infect Dis 2020; 71:1120-1123. [PMID: 32797219 DOI: 10.1093/cid/ciz1012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | - Jason D Simmons
- Department of Medicine, University of Washington, Seattle, Washington, USA
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3
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Guevara BEK, Saleem S, Chen WT, Hsiao PF, Wu YH. Lucio phenomenon mimicking antiphospholipid syndrome: The occurrence of antiphospholipid antibodies in a leprosy patient. J Cutan Pathol 2019; 46:347-352. [PMID: 30666664 DOI: 10.1111/cup.13425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 12/23/2018] [Accepted: 01/14/2019] [Indexed: 11/30/2022]
Abstract
Lucio phenomenon is an atypical reaction of leprosy, characterized by vasculitic lesions that can mimic antiphospholipid syndrome (APS) clinically. Distinguishing the two can be difficult as antiphospholipid autoantibodies may be present in patients with leprosy. We report on a 32-year-old female patient presenting with a sudden onset of fever, hemorrhagic bullae, and skin necrosis on her lower legs. She was treated for APS due to the presence of antiphospholipid antibodies but had an inadequate response. A skin biopsy revealed thrombotic vasculopathy and necrotizing vasculitis associated with aggregation of foam cells in the perivascular area and subcutis, with acid-fast bacilli in the histiocytes and blood vessel walls. Direct immunofluorescence showed IgM, C3, and fibrinogen deposition in the superficial and deep dermal blood vessels. The pathology confirmed the diagnosis of Lucio phenomenon, and appropriate therapy was given. It is essential to evaluate the patient comprehensively, including clinical, serological, and pathological aspects, to obtain the correct diagnosis.
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Affiliation(s)
- Bryan E K Guevara
- Department of Dermatology, Southern Philippines Medical Center, Davao, Philippines.,Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Suhail Saleem
- Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan.,Consultant Pathologist, Noble Diagnostics, Kannur, Kerala, India
| | - Wan-Ting Chen
- Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Pa-Fan Hsiao
- Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Cosmetic Application and Management, Mackay Medicine, Nursing and Management College, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Yu-Hung Wu
- Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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4
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Abdelmaksoud A. Recurrent deep venous thrombosis in a leprosy patient on Sofosbuvir regimen for HCV: a lepra reaction? Int J Dermatol 2018; 57:e98-e100. [PMID: 29974941 DOI: 10.1111/ijd.14135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 04/19/2018] [Accepted: 06/13/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Ayman Abdelmaksoud
- Mansoura Dermatology, Venerology and Leprology Hospital, Mansoura, Egypt
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5
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Kuo KL, Chen CB, Chi MH, Kuo TT. Pustular type 2 reaction of lepromatous leprosy with presence of antiphospholipid antibodies: A case report and literature review. DERMATOL SIN 2017. [DOI: 10.1016/j.dsi.2016.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
Mycobacterium leprae must adopt a metabolic strategy and undergo various metabolic alterations upon infection to survive inside the human body for years in a dormant state. A change in lipid homeostasis upon infection is highly pronounced in Mycobacterium leprae. Lipids play an essential role in the survival and pathogenesis of mycobacteria. Lipids are present in several forms and serve multiple roles from being a source of nutrition, providing rigidity, evading the host immune response to serving as virulence factors, etc. The synthesis and degradation of lipids is a highly regulated process and is the key to future drug designing and diagnosis for mycobacteria. In the current review, an account of the distinct roles served by lipids, the mechanism of their synthesis and degradation has been elucidated.
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Affiliation(s)
- Gurkamaljit Kaur
- Research Scholar, Department of Biotechnology, Panjab University, Chandigarh 160014, India
| | - Jagdeep Kaur
- Department of Biotechnology, Panjab University, Chandigarh 160014, India
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7
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Molecular Pathogenesis of Leprosy. CURRENT TROPICAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40475-016-0094-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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8
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Wong-Baeza C, Reséndiz-Mora A, Donis-Maturano L, Wong-Baeza I, Zárate-Neira L, Yam-Puc JC, Calderón-Amador J, Medina Y, Wong C, Baeza I, Flores-Romo L. Anti-Lipid IgG Antibodies Are Produced via Germinal Centers in a Murine Model Resembling Human Lupus. Front Immunol 2016; 7:396. [PMID: 27746783 PMCID: PMC5040728 DOI: 10.3389/fimmu.2016.00396] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 09/16/2016] [Indexed: 12/27/2022] Open
Abstract
Anti-lipid IgG antibodies are produced in some mycobacterial infections and in certain autoimmune diseases [such as anti-phospholipid syndrome, systemic lupus erythematosus (SLE)]. However, few studies have addressed the B cell responses underlying the production of these immunoglobulins. Anti-lipid IgG antibodies are consistently found in a murine model resembling human lupus induced by chlorpromazine-stabilized non-bilayer phospholipid arrangements (NPA). NPA are transitory lipid associations found in the membranes of most cells; when NPA are stabilized they can become immunogenic and induce specific IgG antibodies, which appear to be involved in the development of the mouse model of lupus. Of note, anti-NPA antibodies are also detected in patients with SLE and leprosy. We used this model of lupus to investigate in vivo the cellular mechanisms that lead to the production of anti-lipid, class-switched IgG antibodies. In this murine lupus model, we found plasma cells (Gr1−, CD19−, CD138+) producing NPA-specific IgGs in the draining lymph nodes, the spleen, and the bone marrow. We also found a significant number of germinal center B cells (IgD−, CD19+, PNA+) specific for NPA in the draining lymph nodes and the spleen, and we identified in situ the presence of NPA in these germinal centers. By contrast, very few NPA-specific, extrafollicular reaction B cells (B220+, Blimp1+) were found. Moreover, when assessing the anti-NPA IgG antibodies produced during the experimental protocol, we found that the affinity of these antibodies progressively increased over time. Altogether, our data indicate that, in this murine model resembling human lupus, B cells produce anti-NPA IgG antibodies mainly via germinal centers.
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Affiliation(s)
- Carlos Wong-Baeza
- Department of Cell Biology, Center for Research and Advanced Studies, CINVESTAV-IPN, National Polytechnic Institute, Mexico City, Mexico; Laboratorio de Biomembranas, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas (ENCB), IPN, Ciudad de México, México
| | - Albany Reséndiz-Mora
- Laboratorio de Biomembranas, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas (ENCB), IPN , Ciudad de México , México
| | - Luis Donis-Maturano
- Department of Cell Biology, Center for Research and Advanced Studies, CINVESTAV-IPN, National Polytechnic Institute , Mexico City , Mexico
| | - Isabel Wong-Baeza
- Laboratorio de Inmunología Molecular II, Departamento de Inmunología, ENCB, IPN , Ciudad de México , México
| | - Luz Zárate-Neira
- Laboratorio de Biomembranas, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas (ENCB), IPN , Ciudad de México , México
| | - Juan Carlos Yam-Puc
- Department of Cell Biology, Center for Research and Advanced Studies, CINVESTAV-IPN, National Polytechnic Institute , Mexico City , Mexico
| | - Juana Calderón-Amador
- Department of Cell Biology, Center for Research and Advanced Studies, CINVESTAV-IPN, National Polytechnic Institute , Mexico City , Mexico
| | - Yolanda Medina
- Laboratory of monoclonal antibodies, Institute of Epidemiological Diagnosis and Reference , Mexico City , Mexico
| | - Carlos Wong
- Laboratorio de Biomembranas, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas (ENCB), IPN , Ciudad de México , México
| | - Isabel Baeza
- Laboratorio de Biomembranas, Departamento de Bioquímica, Escuela Nacional de Ciencias Biológicas (ENCB), IPN , Ciudad de México , México
| | - Leopoldo Flores-Romo
- Department of Cell Biology, Center for Research and Advanced Studies, CINVESTAV-IPN, National Polytechnic Institute , Mexico City , Mexico
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9
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Aftab H, Nielsen SD, Bygbjerg IC. Leprosy in Denmark 1980-2010: a review of 15 cases. BMC Res Notes 2016; 9:10. [PMID: 26732436 PMCID: PMC4700577 DOI: 10.1186/s13104-015-1768-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 11/30/2015] [Indexed: 12/28/2022] Open
Abstract
Background Leprosy, caused by Mycobacterium leprae, is a chronic and progressive granulomatous disease affecting mainly the skin and the peripheral nervous system. If left unrecognized, the infection can lead to permanent nerve damage and disability. The clinical presentation depends on the immune response of the patient and can result in a wide spectrum of symptoms. Leprosy is a rare encounter in Scandinavia but remains endemic in some parts of the world, with some areas reporting an
increasing incidence. We performed a retrospective record review of leprosy cases in Denmark from 1980 to 2010 with the purpose of presenting the most common geographical, demographic and clinical findings and to discuss the diagnostic and therapeutic challenges of patients with leprosy. Case presentation In total 15 cases were reviewed. The majority (87 %) of leprosy patients in Denmark were born in South- and Southeast Asia, and were presumed to have contracted the infection in their countries of origin. Patients were predominately young males (mean age: 28.6 years). Anaesthetic skin lesion with or without nerve enlargement were the most common clinical presentations (73 %). Immunological leprosy reactions were seen in 40 % of the cases. Diagnoses were based on clinical findings and skin biopsies. Treatment length varied but all patients received multidrug regimens. Conclusion Leprosy should be kept in mind when encountering patients with suspicious skin lesions originating from leprosy endemic areas or with history of travel or work in the tropics. Due to the long incubation period with symptoms presenting long after immigration or return, clinicians often do not have the diagnosis in mind. The wide spectrum of symptoms and immunological reactions further complicates the diagnostic process. Treatment of leprosy and the complicated immunological reactions, which frequently accompanies the infection, should be performed in collaboration with a specialist. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1768-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Huma Aftab
- Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen, Denmark. .,Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Susanne D Nielsen
- Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen, Denmark.
| | - Ib C Bygbjerg
- Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen, Denmark. .,Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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10
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Jurado F, Rodriguez O, Novales J, Navarrete G, Rodriguez M. Lucio’s leprosy: A clinical and therapeutic challenge. Clin Dermatol 2015; 33:66-78. [DOI: 10.1016/j.clindermatol.2014.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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11
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Karadeniz A, Lally L, Magro C, Levy R, Erkan D, Lockshin MD. Lepromatous leprosy mimicking systemic lupus erythematosus: a clinical pathology conference held by the division of rheumatology at hospital for special surgery. HSS J 2014; 10:286-91. [PMID: 25264448 PMCID: PMC4171453 DOI: 10.1007/s11420-014-9405-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 06/26/2014] [Indexed: 02/07/2023]
Affiliation(s)
- Asli Karadeniz
- Department of Internal Medicine, Pendik Training and Research Hospital, Marmara University School of Medicine, Mimar Sinan Caddesi No: 41, Fevzi Cakmak Mah. Pendik, Istanbul, Turkey ,Department of Rheumatology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Lindsay Lally
- Department of Rheumatology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Cynthia Magro
- Department of Pathology and Laboratory Medicine, Weill-Cornell New York-Presbyterian Hospital, New York, NY USA
| | - Roger Levy
- Department of Rheumatology, Universidade do Estado do Rio de Janerio, Rio de Janerio, Brazil
| | - Doruk Erkan
- Department of Rheumatology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Michael D. Lockshin
- Department of Rheumatology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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