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Sasso BM, Vallarelli A, Rosa PS, Belone A, Velho P, Cintra ML. Macrophage immunophenotypes in Jorge Lobo's disease and lepromatous leprosy- A comparative study. Microb Pathog 2024; 190:106610. [PMID: 38484920 DOI: 10.1016/j.micpath.2024.106610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 03/24/2024]
Abstract
Jorge Lobo's disease (JLD) and lepromatous leprosy (LL) share several clinical, histological and immunological features, especially a deficiency in the cellular immune response. Macrophages participate in innate and adaptive inflammatory immune responses, as well as in tissue regeneration and repair. Macrophage function deficiency results in maintenance of diseases. M1 macrophages produce pro-inflammatory mediators and M2 produce anti-inflammatory cytokines. To better understand JLD and LL pathogenesis, we studied the immunophenotype profile of macrophage subtypes in 52 JLD skin lesions, in comparison with 16 LL samples, using a panmacrophage (CD68) antibody and selective immunohistochemical markers for M1 (iNOS) and M2 (CD163, CD204) responses, HAM56 (resident/fixed macrophage) and MAC 387 (recently infiltrating macrophage) antibodies. We found no differences between the groups regarding the density of the CD163, CD204, MAC387+ immunostained cells, including iNOS, considered a M1 marker. But HAM56+ cell density was higher in LL samples. By comparing the M2 and M1 immunomarkers in each disease separately, some other differences were found. Our results reinforce a higher M2 response in JLD and LL patients, depicting predominant production of anti-inflammatory cytokines, but also some distinction in degree of macrophage activation. Significant amounts of iNOS + macrophages take part in the immune milieu of both LL and JLD samples, displaying impaired microbicidal activity, like alternatively activated M2 cells.
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Affiliation(s)
- B M Sasso
- State University of Campinas (UNICAMP), Campinas, Brazil.
| | - Afa Vallarelli
- State University of Campinas (UNICAMP), Campinas, Brazil
| | - P S Rosa
- Lauro de Souza Lima Institute (ILSL), Bauru, Brazil
| | - Aff Belone
- Lauro de Souza Lima Institute (ILSL), Bauru, Brazil
| | - Penf Velho
- State University of Campinas (UNICAMP), Campinas, Brazil
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2
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Vangala NN, Madke B, Kashikar Y, Mahajan S. Infiltrated and nodular pinna in lepromatous leprosy. BMJ Case Rep 2024; 17:e259406. [PMID: 38663896 PMCID: PMC11043710 DOI: 10.1136/bcr-2023-259406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Affiliation(s)
- Naga Nitya Vangala
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India
| | - Bhushan Madke
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India
| | - Yash Kashikar
- Department of Dermatology, Venereology and Leprosy, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India
| | - Shital Mahajan
- Department of Microbiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, India
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3
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Gogate S, Khurana A, Ahuja A, Sardana K. Trans-epidermal extrusion of lepra bacilli from histoid lesions: a risk of continued transmission. Int J Dermatol 2024; 63:521-523. [PMID: 38235837 DOI: 10.1111/ijd.17035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 01/04/2024] [Accepted: 01/04/2024] [Indexed: 01/19/2024]
Abstract
The current goal of Zero Leprosy focuses on the interruption of the transmission of infection within endemic regions. While the role of the skin in the transmission dynamics of leprosy has not been clearly delineated, recent research on the environmental presence of lepra bacilli brings this aspect back into focus. We present a case of lepromatous leprosy with perforated-appearing histoid lesions on the palms and soles, demonstrating the presence of lepra bacilli throughout the epidermis.
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Affiliation(s)
- Siddharth Gogate
- Department of Dermatology, Venereology and Leprosy and Department of Pathology, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Ananta Khurana
- Department of Dermatology, Venereology and Leprosy and Department of Pathology, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Arvind Ahuja
- Department of Dermatology, Venereology and Leprosy and Department of Pathology, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
| | - Kabir Sardana
- Department of Dermatology, Venereology and Leprosy and Department of Pathology, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
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Matono T, Suzuki S, Mori S, Ato M. Case Report: Borderline Lepromatous Leprosy Therapy Complicated by Type 1 Leprosy Reaction and Adverse Reactions with Dapsone and Clofazimine. Am J Trop Med Hyg 2024; 110:483-486. [PMID: 38266303 PMCID: PMC10919175 DOI: 10.4269/ajtmh.22-0637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/16/2023] [Indexed: 01/26/2024] Open
Abstract
Leprosy is a global health issue, causing long-term functional morbidity and stigma. Rapid diagnosis and appropriate treatment are important; however, early diagnosis is often challenging, especially in nonendemic areas. Here, we report a case of borderline lepromatous leprosy accompanied by dapsone-induced (neutropenia, anemia, and methemoglobinemia) and clofazimine-induced (skin discoloration and ichthyosis) side effects and type 1 leprosy reactions during administration of the multidrug therapy. The patient completely recovered without developing any deformities or visual impairment. To ensure early diagnosis and a favorable outcome, clinicians should be aware of the diminished sensation of skin lesions as a key physical finding and manage the drug toxicities and leprosy reactions appropriately in patients on multidrug therapy.
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Affiliation(s)
- Takashi Matono
- Department of Infectious Diseases, Aso Iizuka Hospital, Fukuoka, Japan
| | - Shotaro Suzuki
- Department of Infectious Diseases, Aso Iizuka Hospital, Fukuoka, Japan
| | - Shuichi Mori
- Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Manabu Ato
- Leprosy Research Center, National Institute of Infectious Diseases, Tokyo, Japan
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Singh S, Narang T, Dogra S. Reverse Koebner phenomenon in erythema nodosum leprosum. Trans R Soc Trop Med Hyg 2024; 118:77-79. [PMID: 37632458 DOI: 10.1093/trstmh/trad066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/19/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Erythema nodosum leprosum (ENL) is an immunologically mediated phenomenon complicating the course of leprosy. Reverse Koebner phenomenon is the term used to describe the sparing of previously injured or diseased skin by new skin lesions of the disease. METHODS A middle-aged woman with a known case of lepromatous leprosy for the past year presented with an eruption of reddish painful nodules over her body. The lesions were found to characteristically spare the sites of previous scars. RESULTS This sparing phenomenon of previous scar sites has been termed reverse Koebner phenomenon, a site of the body that offers greater resistance than the rest of the body to the onset of the disease, seen in various diseases, but it has never been described in ENL. CONCLUSION This sparing of scar sites in ENL can be attributed to reverse Koebner phenomenon.
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Affiliation(s)
- Sukhdeep Singh
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India160012
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India160012
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education and Research, Chandigarh, India160012
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Singh I, Pathak VK, Lavania M, Ahuja M, Sharma R, Narang T, Jain S, Turankar RP, Dogra S, Sengupta U. Genomic characterization of Mycobacterium lepromatosis from ENL patients from India. Infect Genet Evol 2023; 116:105537. [PMID: 38056703 DOI: 10.1016/j.meegid.2023.105537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/08/2023] [Accepted: 12/02/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Leprosy is caused by Mycobacterium leprae and Mycobacterium lepromatosis. Both organisms cannot be cultured in vitro. M. lepromatosis was found to be associated mainly with diffuse lepromatous leprosy and with Lucio's phenomena initially. Later, M. lepromatosis was observed in borderline leprosy cases (BL), lepromatous leprosy cases (LL) and leprosy reactional cases (T1R and ENL). Although many cases are being reported with similar clinical features like Lucio phenomenon in India but M. lepromatosis was not isolated from these cases. The aim of this study was to screen MB patients and patients with type 2 reaction for the presence of M. lepromatosis. METHODOLOGY We recruited a total of 75 multibacillary leprosy cases (45 MB cases without reaction and 30 type 2 reaction (ENL) cases) from TLM hospitals Purulia (West Bengal), Barabanki (Uttar Pradesh), Shahdara (Delhi) and PGIMER (Chandigarh), India. Punch biopsies of 5 mm were collected in 70% ethanol from all the study subjects. DNA was extracted followed by Hemi-nested PCR targeting 16S rRNA gene specific for M. lepromatosis. Further, PCR products were processed for Sanger sequencing for an absolute confirmation of M. lepromatosis. Whole genome sequencing was done to confirm the presence of M. lepromatosis. RESULT We observed presence of M. lepromatosis in 4 necrotic ENL patients by heminested PCR. There was 100% 16S rRNA sequence similarity with M. lepromatosis FJ924 in one case, 98.96% in two cases and in one case it was 90.9% similarity by nucleotide BLAST (BLASTn) by using the NCBI website. On the basis of Sanger sequencing, we noted presence of M. lepromatosis in 3 necrotic ENL patients as one sample only gave 90.9% similarity by BLASTn. On the basis of de novo assembly and genome obtained, only one sample S4 with a 2.9 mb genome size was qualified for downstream analysis. Sixteen M. lepromatosis- specific proteins were identified in this case and the closest species was M. lepromatosis strain FJ924 based on whole genome level phylogeny. CONCLUSION These results provide valuable insights into the prevalence of M. lepromatosis in ENL patients in different regions of India and contribute to our understanding of the genetic characteristics of this pathogen in the context of leprosy.
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Affiliation(s)
- Itu Singh
- Stanley Browne Laboratory, TLM Community Hospital Shahdara, Nand Nagari, Delhi 110093, India.
| | - Vinay Kumar Pathak
- Stanley Browne Laboratory, TLM Community Hospital Shahdara, Nand Nagari, Delhi 110093, India
| | - Mallika Lavania
- Stanley Browne Laboratory, TLM Community Hospital Shahdara, Nand Nagari, Delhi 110093, India; Enteric Viruses Group, ICMR-National Institute of Virology, 20-A Ambedkar Road, Agarkar Nagar, Pune 411001, Maharashtra, India
| | - Madhvi Ahuja
- Stanley Browne Laboratory, TLM Community Hospital Shahdara, Nand Nagari, Delhi 110093, India
| | - Rahul Sharma
- Stanley Browne Laboratory, TLM Community Hospital Shahdara, Nand Nagari, Delhi 110093, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh 160012, India.
| | - Sejal Jain
- Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh 160012, India
| | - Ravindra P Turankar
- Stanley Browne Laboratory, TLM Community Hospital Shahdara, Nand Nagari, Delhi 110093, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, PGIMER, Chandigarh 160012, India
| | - U Sengupta
- Stanley Browne Laboratory, TLM Community Hospital Shahdara, Nand Nagari, Delhi 110093, India
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7
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Biswas D, Sethy M, Behera B, Palit A, Mitra S. Image Morphometric Analysis of B Cells and Plasma Cells in Erythema Nodosum Leprosum With Clinicopathological Correlation. Am J Dermatopathol 2021; 43:700-706. [PMID: 33264135 DOI: 10.1097/dad.0000000000001860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Erythema nodosum leprosum (ENL) occurs as an immunological complication of multibacillary leprosy (MBL). The pathogenesis of ENL is long considered to be a T-cell-mediated process. The role of B cells and plasma cells in ENL is not well described in the literature. Therefore, we investigated the B-cell and plasma cell infiltrates in the skin biopsies of biopsy-proven cases of ENL by immunohistochemistry and image morphometry and compared the result with paucibacillary leprosy and MBL. Moreover, we sought a correlation of the B-cell and plasma cell infiltrates with different clinical, hematological, histopathological, and bacteriological parameters as well as the T-cell subsets in the skin biopsies. Our study highlighted a significant reduction in the number of B cells from paucibacillary leprosy to MBL to ENL, although there was no significant variation in the plasma cell infiltrate. The plasma cell infiltrate correlated with absolute neutrophilia in the blood and the presence of eosinophils in the ENL lesions. Both B cells and plasma cells positively correlated with CD4-positive T-helper cells and the CD8-positive cytotoxic T cells. Besides, the B cells also correlated positively with the CD3-positive pan T cells in the biopsy and negatively correlated with the T-regulatory:T-cell ratio. Our results suggested the role of B cells and plasma cells even at the tissue level in the pathobiogenesis of ENL.
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MESH Headings
- Adolescent
- Adult
- Aged
- Antigens, CD20/metabolism
- B-Lymphocytes/metabolism
- B-Lymphocytes/pathology
- Blood Cell Count
- Child
- Child, Preschool
- Eosinophils/pathology
- Erythema Nodosum/blood
- Erythema Nodosum/immunology
- Erythema Nodosum/pathology
- Female
- Humans
- Immunohistochemistry
- Infant
- Leprosy, Lepromatous/blood
- Leprosy, Lepromatous/immunology
- Leprosy, Lepromatous/pathology
- Leprosy, Paucibacillary/immunology
- Leprosy, Paucibacillary/pathology
- Male
- Middle Aged
- Neutrophils
- Plasma Cells/metabolism
- Plasma Cells/pathology
- Syndecan-1/metabolism
- T-Lymphocytes, Cytotoxic/pathology
- T-Lymphocytes, Helper-Inducer/pathology
- T-Lymphocytes, Regulatory/pathology
- Young Adult
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8
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Tanabe MB, Group AR, Rincon L, Stryjewska BM, Sarria JC. Persistent Infection Versus Type 2 Immunological Reaction in Lepromatous Leprosy. J Investig Med High Impact Case Rep 2021; 8:2324709620927884. [PMID: 32462938 PMCID: PMC7273538 DOI: 10.1177/2324709620927884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The distinction between persistent infection and immunologic reactions in leprosy
is often difficult but critically important since their management is different.
We present the case of a 51-year-old Vietnamese female who presented in 2015
with areas of erythema and skin infiltration on face and chest, as well as edema
on her hands and feet. Skin biopsy was consistent with lepromatous leprosy. She
was treated with rifampin, clarithromycin, and levofloxacin for 2 years. Her
lower extremity edema was attributed to type 2 immunological reaction for which
she was started on prednisone and methotrexate, but she was lost to follow-up
for 19 months. She presented with new skin lesions and pain on her extremities.
New biopsies revealed an intense neutrophilic infiltrate in the dermis and
acid-fast bacilli focally within cutaneous nerve twigs. As compared with the
initial biopsy, the inflammatory infiltrates were diminished and the bacilli had
a degenerating appearance. These findings were consistent with type 2
immunological reaction. The patient was treated with thalidomide with
improvement in the appearance of the skin lesions. A follow-up biopsy showed
lack of neutrophilic infiltrates and decreased number of bacilli. This case
illustrates the importance of differentiating between persistent infection and
immunologic reactions in leprosy. Clinicians should be aware of these
complications. A high index of suspicion and accurate interpretation of skin
biopsy results are essential for appropriate diagnosis.
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Affiliation(s)
- Melinda B. Tanabe
- University of Texas Medical Branch,
Galveston, TX, USA
- Melinda B. Tanabe, MD, Department of
Infectious Diseases, University of Texas Medical Branch, 301 University Blvd,
Route 0435, Galveston, TX 77555, USA.
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9
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Affiliation(s)
- Mahroo Tajalli
- Warren Alpert Medical School of Brown University, Providence, RI
| | - Carlos G Wambier
- Warren Alpert Medical School of Brown University, Providence, RI
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10
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Robati RM, Mozafari N, Bidari-Zerehpoosh F, Niknejad N, Bizaval Z. Lepromatous leprosy presenting with type II reaction before and type I reaction after treatment. Dermatol Online J 2020; 26:13030/qt1f76n0b4. [PMID: 33054941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/07/2020] [Indexed: 06/11/2023] Open
Abstract
Lepromatous leprosy is associated with a high bacillary load and poor cellular immune response. Early dermatologic manifestations include erythematous macules, papules, nodules, and plaques with a symmetrical distribution. Leprosy also shows two major reaction states including type I (reversal reaction) and type II (vasculitis). These reactions are usually seen in some patients who are undergoing treatment. Herein, we report an interesting patient with lepromatous leprosy who presented with skin lesions of type II reaction without receiving any anti-leprosy treatment and surprisingly showed a type I reaction eight months after the beginning of the treatment.
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Affiliation(s)
| | - Nikoo Mozafari
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran Department of Dermatology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran.
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11
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Affiliation(s)
| | | | - Alina Karki
- 1 College of Medical Sciences, Bharatpur, Nepal
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12
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Malhotra KP, Suvirya S, Malhotra HS, Kumar B, Gupta A. Does histoid leprosy represent a locally hyperimmune variant of lepromatous leprosy? QJM 2019; 112:429-435. [PMID: 30778548 DOI: 10.1093/qjmed/hcz043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/02/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Histoid leprosy is a subtype of leprosy with distinct clinical presentation and histologic features. It accounts for <4% of leprosy cases. The exact location of histoid leprosy along the immune spectrum and its relation to other subtypes is unclear. AIM To evaluate the local immune phenomenon which define histoid leprosy. DESIGN Parallel skin biopsies from histoid lesions and from unremarkable skin in patients with histoid leprosy were evaluated and the histologic findings compared. METHODS Formalin fixed, paraffin embedded tissue sections from lesional and non-lesional biopsies were assessed for changes in epidermis and dermis; type and extent of infiltrate, presence or absence of pseudocapsule and associated reactions. Bacillary index was evaluated using Wade Fite stain for lepra bacilli. RESULTS Amongst 208 leprosy cases, six cases of histoid leprosy were identified (2.88%). The cases showed presence of nodules, patches and plaques overlying clinically unremarkable skin. Fourteen skin biopsies were evaluated of which the lesional biopsies showed equal proportion of fusocellular, fusocellular epithelioid and fusocellular-vacuolated histology. A greater circumscription was noted in lesional biopsies; however the cellular content of the infiltrate was similar in lesional and non-lesional biopsies. A case of erythema nodosum leprosum in histoid leprosy was also seen. CONCLUSIONS Ours is the first study comparing normal and lesional skin in histoid leprosy. Though the histoid lesions appear to have a derivation from lepromatous leprosy, the local histologic and clinical alterations may be a result of heightened local immunity or reactive local modifying factors.
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Affiliation(s)
- K P Malhotra
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - S Suvirya
- Department of Dermatology, Venerology and Leprology, King George Medical University, Lucknow, India
| | - H S Malhotra
- Department of Neurology, King George Medical University, Lucknow, India
| | - B Kumar
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
| | - A Gupta
- Department of Pathology, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India
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13
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Baldissera RL, Shwetz GA, Fillus Neto J, Vigo NDR. Erythroderma as a manifestation of leprosy. An Bras Dermatol 2019; 94:89-92. [PMID: 30726471 PMCID: PMC6360983 DOI: 10.1590/abd1806-4841.20197887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/02/2018] [Indexed: 11/22/2022] Open
Abstract
Erythroderma consists of erythema and scaling involving most or all of the body surface. This generalized eruption may be idiopathic, drug-induced or secondary to cutaneous or systemic disease. A 71-year-old man is reported presenting generalized erythema and desquamation with deck-chair sign, nail dystrophy, and plantar ulcers associated with loss of local tactile sensitivity. Biopsies from three different sites demonstrated diffuse lymphocytic infiltrate with incipient granulomas. Fite-Faraco staining showed numerous isolated bacilli and globi. The skin smear was positive. Clinical and pathological diagnosis of borderline lepromatous leprosy was confirmed. This report demonstrates that chronic multibacillary leprosy can manifest as erythroderma and thus should be included in the differential diagnosis.
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MESH Headings
- Aged
- Biopsy
- Dermatitis, Exfoliative/complications
- Dermatitis, Exfoliative/diagnosis
- Dermatitis, Exfoliative/pathology
- Diagnosis, Differential
- Humans
- Leprosy, Borderline/diagnosis
- Leprosy, Borderline/etiology
- Leprosy, Borderline/pathology
- Leprosy, Lepromatous/diagnosis
- Leprosy, Lepromatous/etiology
- Leprosy, Lepromatous/pathology
- Male
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Affiliation(s)
- Renato Luiz Baldissera
- Department of Dermatology, Hospital Universitário
Evangélico de Curitiba, Faculdade Evangélica do Paraná,
Curitiba (PR), Brazil
| | - Guilherme Athanasio Shwetz
- Department of Dermatology, Hospital Universitário
Evangélico de Curitiba, Faculdade Evangélica do Paraná,
Curitiba (PR), Brazil
| | - José Fillus Neto
- Department of Dermatology, Hospital Universitário
Evangélico de Curitiba, Faculdade Evangélica do Paraná,
Curitiba (PR), Brazil
| | - Noely do Rocio Vigo
- Department of Dermatology, Hospital Universitário
Evangélico de Curitiba, Faculdade Evangélica do Paraná,
Curitiba (PR), Brazil
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14
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Virk A, Pritt B, Patel R, Uhl JR, Bezalel SA, Gibson LE, Stryjewska BM, Peters MS. Mycobacterium lepromatosis Lepromatous Leprosy in US Citizen Who Traveled to Disease-Endemic Areas. Emerg Infect Dis 2018; 23:1864-1866. [PMID: 29048278 PMCID: PMC5652441 DOI: 10.3201/eid2311.171104] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report Mycobacterium lepromatosis infection in a US-born person with an extensive international travel history. Clinical symptoms, histopathology, and management are similar to those of infections caused by M. leprae. Clinicians should consider this pathogen in the diagnosis of patients with symptoms of leprosy who have traveled to endemic areas.
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15
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Abstract
Background Facial deformation as a sequela of leprosy is caused not only by a saddle nose but also by regression of the maxilla, as well documented in paleopathological observations of excavated skeletal remains of patients with leprosy. However, maxillary changes in living patients have been evaluated only by the subjective visual grading. Here, we attempted to evaluate maxillary bone deformation in patients with leprosy using three-dimensional computed tomography (3D-CT). Methods Three-dimensional images centered on the maxilla were reconstructed using multiplanar reconstruction methods in former patients with leprosy (n = 10) and control subjects (n = 5); the anterior-posterior length of the maxilla (MA-P) was then measured. The difference between the MA-P of the patients and those of controls was evaluated after compensating for individual skull size. These findings were also compared with those from previous paleopathological studies. Findings Three former patients with lepromatous leprosy showed marked atrophy of the maxilla at the prosthion (-8.6, -11.1 and -17.9 mm) which corresponded with the visual appearance of the maxillary deformity, and these results were consistent with paleopathological findings of excavated skeletal remains. Additionally, the precise bone defects of the maxilla could be individually calculated for accurate reconstructive surgery. Interpretation We have successfully illustrated maxillary bone deformities in living patients with leprosy. This study also confirmed the maxillary regression described in paleopathological studies. The sequelae of leprosy are diverse and include facial deformity. A characteristic facial deformity is saddle nose, and the common clinical approach to this facial deformity has been rhinoplasty. Paleopathological studies from excavated skeletal remains have revealed that leprosy also causes deformation of the maxillary bone, which supports the external nose; however, these changes have not been evaluated in living patients with leprosy. In this study, we reconstructed three-dimensional and stereoscopic images of the cranium from CT scan data and evaluated maxillary deformities both qualitatively and quantitatively. Out of the ten former patients with leprosy, three had severe deformity of the maxilla including: atrophy of the anterior nasal spine, resorption of the medial part of the alveolar process, loss of sharpness of the piriform aperture margins, and atrophy of the nasal turbinate and the septum. These changes were consistent with previous findings from paleopathological studies. We also developed a novel method for measuring the anterior-posterior length of the maxilla using 3D-CT images, with compensation for individual differences in cranial size. The calculated values are indicative of the severity of the maxillary defects as well as the thickness of bone that needs to be reconstructed to correct the deformed maxilla.
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Affiliation(s)
- Norio Kasai
- Department of Otolaryngology, National Sanatorium Oku-Komyoen, Setouchi City, Okayama, Japan
- Department of Otolaryngology, National Sanatorium Nagashima-Aiseien, Setouchi City, Okayama, Japan
| | - Osamu Kondo
- Department of Biological Sciences, Graduate School of Science, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Koichi Suzuki
- Department of Clinical Laboratory Science, Faculty of Medical Technology, Teikyo University, Itabashi-ku, Tokyo, Japan
- Leprosy Research Center, National Institute of Infectious Diseases, Higashimurayama, Tokyo, Japan
| | - Yoshinori Aoki
- Department of Otolaryngology, National Sanatorium Oku-Komyoen, Setouchi City, Okayama, Japan
| | - Norihisa Ishii
- Leprosy Research Center, National Institute of Infectious Diseases, Higashimurayama, Tokyo, Japan
| | - Masamichi Goto
- National Sanatorium Hoshizuka-Keiaien, Kanoya, Kagoshima, Japan
- * E-mail:
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16
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Abstract
Brazil is a country with a high prevalence of infectious diseases such as leprosy and leishmaniasis. However, coinfection of these diseases is still poorly understood. We report a case of a patient who presented with lepromatous leprosy and cutaneous-mucosal leishmaniasis at the same period. After clinical, laboratory, and histopathological diagnosis, the treatment was introduced and the patient showed important clinical improvement. He was followed in our outpatient clinic. Both pathologies play an important role in the immune system. Depending on the immune response profile of the host, diseases may present themselves in different ways. In this case, the patient showed a divergent immune response for each disease. We hypothesized that this response is specific for each pathogen.
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Affiliation(s)
| | | | - Elisangela Samartin Pegas
- Leprosy Outpatient Service at Pontifícia
Universidade Católica de Campinas (PUC - Campinas) - Campinas (SP),
Brazil
| | - Bogdana Victória Kadunc
- Dermatology Service at Pontifícia Universidade
Católica de Campinas (PUC - Campinas) - Campinas (SP), Brazil
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17
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Silva LM, Hirai KE, de Sousa JR, de Souza J, Dias LB, Carneiro FRO, Aarão TLDS, Fuzii HT, Quaresma JAS. NFκB transcription factor (p65) immunohistochemistry in leprosy dermal microvasculature. Microb Pathog 2017; 113:427-431. [PMID: 29170041 DOI: 10.1016/j.micpath.2017.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 11/11/2017] [Accepted: 11/18/2017] [Indexed: 11/18/2022]
Abstract
Leprosy caused by Mycobacterium leprae is characterized by a spectrum of clinical manifestations that are determined by the predominant immunological profile of the host. The recruitment of leukocytes to the sites of injury can influence the development of these profiles. Cell adhesion molecules such as ICAM-1, VCAM-1 and CD62E participate in this process and their expression is regulated by transcriptions factors such as NFκB. To correlate the expression of cell adhesion molecules and NFκB (p65) in leprosy lesions, 30 skin biopsies of patients with leprosy [16 with the tuberculoid (TT) or borderline tuberculoid (BT) forms and 14 with the lepromatous (LL) or borderline lepromatous (BL) forms] were analyzed by immunohistochemistry. A larger mean number of cells expressing VCAM-1 (BT/TT: 18.28 ± 1.4; BL/LL: 10.67 ± 1.2; p = 0.0002), ICAM-1 (BT/TT: 9.92 ± 1.1; BL/LL: 5.87 ± 1.0; p = 0.0084) and CD62E (BT/TT: 13.0 ± 1.5; BL/LL: 2.58 ± 0.3; p = 0.0001) were observed in BT and TT lesions. The mean number of cells expressing NFκB was similar in the two clinical forms (BT/TT: 2.21 ± 2.7; BL/LL: 2.35 ± 3.1;p = 0.9285). No significant correlation was observed between expression of the transcription factor and adhesion molecules analyzed. The synthesis of ICAM-1, VCAM-1 and CD62E depends on the activation of NFκB, which acts synergistically with other transcription factors. Adequate activation of intracellular signaling pathways results in the production of endothelial adhesion molecules, contributing to the recruitment of cells to the site of injury and thus eliciting an effective inflammatory response in the elimination of the bacillus.
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Affiliation(s)
- Luciana Mota Silva
- Center of Biological and Health Science, State University of Para, Belem, Brazil
| | - Kelly Emi Hirai
- Center of Biological and Health Science, State University of Para, Belem, Brazil
| | | | - Juarez de Souza
- Center of Biological and Health Science, State University of Para, Belem, Brazil
| | - Leônidas Braga Dias
- Center of Biological and Health Science, State University of Para, Belem, Brazil
| | | | | | | | - Juarez Antonio Simões Quaresma
- Center of Biological and Health Science, State University of Para, Belem, Brazil; Tropical Medicine Center, Federal do Para University, Belem, Brazil.
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18
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Harb J, Pothiawala S, Yonkosky D, Talley J, Jukic D. Two Cases of Lepromatous Leprosy from Exposure to Armadillos in Florida. Skinmed 2017; 15:391-393. [PMID: 29139372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The first patient was a 41-year-old white man who was referred to the dermatology clinic with a 2-year history of numerous erythematous, hypoesthetic, poorly demarcated papules and plaques present on the trunk, buttocks, and bilateral upper and lower extremities (Figures 1 and 2). The lesions had initially begun as localized erythematous plaques on the right flank, and were diagnosed and treated as cellulitis and allergic contact dermatitis by primary care on separate occasions, with no resolution and continued gradual but persistent spread.
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Affiliation(s)
- Jennifer Harb
- Department of Dermatology, University of Florida College of Medicine, Gainesville, FL;
| | - Salma Pothiawala
- Department of Dermatology and Cutaneous Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL
| | - Donna Yonkosky
- Department of Dermatology, Orlando VA Medical Center, Orlando, FL
| | - James Talley
- Department of Dermatology, Orlando VA Medical Center, Orlando, FL
| | - Drazen Jukic
- Department of Dermatopathology, James A. Haley Veterans Hospital, Tampa, FL
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19
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Negera E, Walker SL, Girma S, Doni SN, Tsegaye D, Lambert SM, Idriss MH, Tsegay Y, Dockrell HM, Aseffa A, Lockwood DN. Clinico-pathological features of erythema nodosum leprosum: A case-control study at ALERT hospital, Ethiopia. PLoS Negl Trop Dis 2017; 11:e0006011. [PMID: 29028793 PMCID: PMC5656324 DOI: 10.1371/journal.pntd.0006011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 10/25/2017] [Accepted: 10/04/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Leprosy reactions are a significant cause of morbidity in leprosy population. Erythema nodosum leprosum (ENL) is an immunological complication affecting approximately 50% of patients with lepromatous leprosy (LL) and 10% of borderline lepromatous (BL) leprosy. ENL is associated with clinical features such as skin lesions, neuritis, arthritis, dactylitis, eye inflammation, osteitis, orchitis, lymphadenitis and nephritis. ENL is treated mainly with corticosteroids and corticosteroids are often required for extended periods of time which may lead to serious adverse effects. High mortality rate and increased morbidity associated with corticosteroid treatment of ENL has been reported. For improved and evidence-based treatment of ENL, documenting the systems affected by ENL is important. We report here the clinical features of ENL in a cohort of patients with acute ENL who were recruited for a clinico-pathological study before and after prednisolone treatment. MATERIALS AND METHODS A case-control study was performed at ALERT hospital, Ethiopia. Forty-six LL patients with ENL and 31 non-reactional LL matched controls were enrolled to the study and followed for 28 weeks. Clinical features were systematically documented at three visits (before, during and after predinsolone treatment of ENL cases) using a specifically designed form. Skin biopsy samples were obtained from each patient before and after treatment and used for histopathological investigations to supplement the clinical data. RESULTS Pain was the most common symptom reported (98%) by patients with ENL. Eighty percent of them had reported skin pain and more than 70% had nerve and joint pain at enrolment. About 40% of the patients developed chronic ENL. Most individuals 95.7% had nodular skin lesions. Over half of patients with ENL had old nerve function impairment (NFI) while 13% had new NFI at enrolment. Facial and limb oedema were present in 60% patients. Regarding pathological findings before treatment, dermal neutrophilic infiltration was noted in 58.8% of patients with ENL compared to 14.3% in LL controls. Only 14.7% patients with ENL had evidence of vasculitis at enrolment. CONCLUSION In our study, painful nodular skin lesions were present in all ENL patients. Only 58% patients had dermal polymorphonuclear cell infiltration showing that not all clinically confirmed ENL cases have neutrophilic infiltration in lesions. Very few patients had histological evidence of vasculitis. Many patients developed chronic ENL and these patients require inpatient corticosteroid treatment for extended periods which challenges the health service facility in resource poor settings, as well as the patient's quality of life.
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Affiliation(s)
- Edessa Negera
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Stephen L. Walker
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Selfu Girma
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | | | | | | | - Munir H. Idriss
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Yohanis Tsegay
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Hazel M. Dockrell
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Abraham Aseffa
- Armauer Hansen Research Institute (AHRI), Addis Ababa, Ethiopia
| | - Diana N. Lockwood
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
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20
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Walker SL, Sales AM, Butlin CR, Shah M, Maghanoy A, Lambert SM, Darlong J, Rozario BJ, Pai VV, Balagon M, Doni SN, Hagge DA, Nery JAC, Neupane KD, Baral S, Sangma BA, Alembo DT, Yetaye AM, Hassan BA, Shelemo MB, Nicholls PG, Lockwood DNJ. A leprosy clinical severity scale for erythema nodosum leprosum: An international, multicentre validation study of the ENLIST ENL Severity Scale. PLoS Negl Trop Dis 2017; 11:e0005716. [PMID: 28671966 PMCID: PMC5510881 DOI: 10.1371/journal.pntd.0005716] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 07/14/2017] [Accepted: 06/16/2017] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES We wished to validate our recently devised 16-item ENLIST ENL Severity Scale, a clinical tool for measuring the severity of the serious leprosy associated complication of erythema nodosum leprosum (ENL). We also wished to assess the responsiveness of the ENLIST ENL Severity Scale in detecting clinical change in patients with ENL. METHODS Participants, recruited from seven centres in six leprosy endemic countries, were assessed using the ENLIST ENL Severity Scale by two researchers, one of whom categorised the severity of ENL. At a subsequent visit a further assessment using the scale was made and both participant and physician rated the change in ENL using the subjective categories of "Much better", "somewhat better", "somewhat worse" and "much worse" compared with "No change" or "about the same". RESULTS 447 participants were assessed with the ENLIST ENL Severity Scale. The Cronbach alpha of the scale and each item was calculated to determine the internal consistency of the scale. The ENLIST ENL Severity Scale had good internal consistency and this improved following removal of six items to give a Cronbach's alpha of 0.77. The cut off between mild ENL and more severe disease was 9 determined using ROC curves. The minimal important difference of the scale was determined to be 5 using both participant and physician ratings of change. CONCLUSIONS The 10-item ENLIST ENL Severity Scale is the first valid, reliable and responsive measure of ENL severity and improves our ability to assess and compare patients and their treatments in this severe and difficult to manage complication of leprosy. The ENLIST ENL Severity Scale will assist physicians in the monitoring and treatment of patients with ENL. The ENLIST ENL Severity Scale is easy to apply and will be useful as an outcome measure in treatment studies and enable the standardisation of other clinical and laboratory ENL research.
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Affiliation(s)
- Stephen L. Walker
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Anna M. Sales
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | - C. Ruth Butlin
- Department of Medicine, The Leprosy Mission International, Dhaka, Bangladesh
| | - Mahesh Shah
- Department of Dermatology and Mycobacterial Research Laboratories, The Leprosy Mission Nepal, Anandaban Hospital, Kathmandu, Nepal
| | - Armi Maghanoy
- Department of Dermatology, Leonard Wood Memorial Center for TB and Leprosy Research, Cebu, Philippines
| | - Saba M. Lambert
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Family Medicine, Suisse Clinic, Addis Ababa, Ethiopia
| | - Joydeepa Darlong
- Department of Medicine, The Leprosy Mission Hospital, Purulia, India
| | | | | | - Marivic Balagon
- Department of Dermatology, Leonard Wood Memorial Center for TB and Leprosy Research, Cebu, Philippines
| | | | - Deanna A. Hagge
- Department of Dermatology and Mycobacterial Research Laboratories, The Leprosy Mission Nepal, Anandaban Hospital, Kathmandu, Nepal
| | - José A. C. Nery
- Leprosy Laboratory, Oswaldo Cruz Institute, Fiocruz, Rio de Janeiro, Brazil
| | - Kapil D. Neupane
- Department of Dermatology and Mycobacterial Research Laboratories, The Leprosy Mission Nepal, Anandaban Hospital, Kathmandu, Nepal
| | - Suwash Baral
- Department of Dermatology and Mycobacterial Research Laboratories, The Leprosy Mission Nepal, Anandaban Hospital, Kathmandu, Nepal
| | - Biliom A. Sangma
- Department of Medicine, The Leprosy Mission International, Dhaka, Bangladesh
| | | | - Abeba M. Yetaye
- Department of Dermatology, ALERT Center, Addis Ababa, Ethiopia
| | | | | | - Peter G. Nicholls
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Diana N. J. Lockwood
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
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21
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Gómez-Camarasa C, Rodríguez-Granger J, Cañadas-Moreno O, Sampedro A, Aliaga-Martínez L, Cobo F. Autochthonous lepromatous leprosy in a Spanish woman with burns on both feet and skin lesions. LEPROSY REV 2016; 87:532-535. [PMID: 30226357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The incidence of leprosy is decreasing worldwide and it is considered a rare disease in developed countries. In Spain, leprosy is mainly an imported disease with only few autochthonous cases seen. The diagnosis is difficult because of a low index of suspicion and the absence of visualisation of fast-acid bacilli in the lesions. Here, we report an autochthonous case of leprosy diagnosed after 4 years of evolution of skin lesions. Mechanical rupture of the biopsy helped finally to make the correct diagnosis of the disease.
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22
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Ma S, Kovarik C. Erythema and induration on the right ear and maxilla. Cutis 2016; 98:26-30. [PMID: 27529711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Sophia Ma
- Department of Pathology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Carrie Kovarik
- Departments of Dermatology, Dermatopathology, and Infectious Diseases, Hospital of the University of Pennsylvania, Philadelphia, USA
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23
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Rambhia KD, Khopkar US. Elastophagocytosis and Elastolysis in Leprosy. Indian J Lepr 2016; 88:129-131. [PMID: 29757546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Elastophagocytosis is the engulfment of the elastic fibres by the histiocytes, multinucleated giant cells, or both. The cutaneous lesions showing elastophagocytosis are annular elastolytic giant cell granuloma, actinic keratoses, persistent insect-bite reactions, elastosis perforans serpiginosa, foreign body granuloma. Occasionally, it may occur in infectious diseases like leprosy, granulomatous syphilis, North-American blastomycosis, bacterial folliculitis, and cutaneous leishmaniasis. We report a case of lepromatous leprosy with necrotic erythema nodosum leprosum with secondary anetoderma. Histopathology from the atrophic macule of anetoderma revealed periappendageal, perineural infiltration, elastophagocytosis and reduction in elastic fibres.
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24
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Affiliation(s)
- Jesús Salvador Velarde-Félix
- *Address correspondence to Jesús Salvador Velarde-Félix, Centro de Medicina Genómica del Hospital General de Culiacán Bernardo J. Gastélum, Juan Aldama y Nayarit S/N, Col. Rosales, 80230 Culiacán, Sinaloa, México. E-mail:
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25
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Hattori M, Motegi SI, Amano H, Ishii N, Ishikawa O. Borderline Lepromatous Leprosy: Cutaneous Manifestation and Type 1 Reversal Reaction. Acta Derm Venereol 2016; 96:422-3. [PMID: 26439279 DOI: 10.2340/00015555-2251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mai Hattori
- Department of Dermatology, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
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26
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Coelho de Sousa V, Laureano A, Cardoso J. Wade histoid leprosy revisited. Dermatol Online J 2016; 22:13030/qt5d78t619. [PMID: 27267191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 06/06/2023] Open
Abstract
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.
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27
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Wang N, Liu H, Zhang F. A Lepromatous Leprosy Patient with Permanent Disability. Am J Trop Med Hyg 2015; 93:896-898. [PMID: 26537774 PMCID: PMC4703287 DOI: 10.4269/ajtmh.14-0843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | - Furen Zhang
- *Address correspondence to Furen Zhang, Shandong Provincial Institute of Dermatovenereology, 27397 Jingshi Lu, Jinan 250022, Shandong Province, People's Republic of China. E-mail:
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28
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Abstract
Histoid leprosy is rare type of lepromatous leprosy characterized by unique clinical, histopathological, and microbiological features. It is characterized by cutaneous and subcutaneous nodules. Histoid leprosy cases represent probable resistant bacilli and a highly active lepromatous process. These cases may act as reservoirs of the disease and lead to further spread of leprosy. Continual occurrence of these cases does not bode well for eradication of leprosy.
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Affiliation(s)
- Kaliaperumal Karthikeyan
- *Address of correspondence to Kaliaperumal Karthikeyan, Department of Dermatology and STD, Sri Manakula Vinayagar Medical College and Hospital, 41, Vellala Street, Kalitheerthalkuppam, Puducherry 605001, India. E-mail:
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29
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Khodke A, Shetty VP. Type 1 reaction masquerading clinically as ENL: A Case Report. LEPROSY REV 2015; 86:202-205. [PMID: 26502694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Attention is drawn to a Type 1 reaction masquerading clinically as ENL. Histology showed no evidence of ENL but suggested heightened T-cell activity (CMI), a characteristic feature of Type 1 reaction. We present a case of a 29 year old man diagnosed as lepromatous leprosy with recurrent Type 2 reaction treated with thalidomide for 2 years. The patient was referred to our institute from a teaching hospital. Skin biopsies were carried out during two separate eruptive episodes 2 months apart. Histopathology showed heightened T-cell activity, but no evidence of ENL.
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30
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Ahmed Z. A case of lepromatous leprosy with co-existing tuberculosis verrucosa cutis (TVC). LEPROSY REV 2015; 86:176-179. [PMID: 26502689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The association of leprosy and cutaneous tuberculosis has been reported rarely. Though cross-immunity may exist between these two mycobacterial infections, tuberculosis can occur throughout the spectrum of leprosy. We report a case of lepromatous leprosy with Type II reaction, with tuberculosis verrucosa cutis (TVC). The patient presented with multiple skin-coloured tender nodules of variable size, involving the upper and lower extremities, nodular enlargement of both ear lobes, erythematous plaques on the face and icthyotic patches over both lower legs and feet, for 6 months. There was also a slow-growing asymptomatic warty plaque over the right lateral malleolus, present for 1 year. Slit skin smear examination from ear lobes, forehead and nodules, and histopathology of the warty lesion, respectively confirmed the diagnoses of leprosy and tuberculosis.
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31
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Inskip SA, Taylor GM, Zakrzewski SR, Mays SA, Pike AWG, Llewellyn G, Williams CM, Lee OYC, Wu HHT, Minnikin DE, Besra GS, Stewart GR. Osteological, biomolecular and geochemical examination of an early anglo-saxon case of lepromatous leprosy. PLoS One 2015; 10:e0124282. [PMID: 25970602 PMCID: PMC4430215 DOI: 10.1371/journal.pone.0124282] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/12/2015] [Indexed: 11/19/2022] Open
Abstract
We have examined a 5th to 6th century inhumation from Great Chesterford, Essex, UK. The incomplete remains are those of a young male, aged around 21-35 years at death. The remains show osteological evidence of lepromatous leprosy (LL) and this was confirmed by lipid biomarker analysis and ancient DNA (aDNA) analysis, which provided evidence for both multi-copy and single copy loci from the Mycobacterium leprae genome. Genotyping showed the strain belonged to the 3I lineage, but the Great Chesterford isolate appeared to be ancestral to 3I strains found in later medieval cases in southern Britain and also continental Europe. While a number of contemporaneous cases exist, at present, this case of leprosy is the earliest radiocarbon dated case in Britain confirmed by both aDNA and lipid biomarkers. Importantly, Strontium and Oxygen isotope analysis suggest that the individual is likely to have originated from outside Britain. This potentially sheds light on the origins of the strain in Britain and its subsequent spread to other parts of the world, including the Americas where the 3I lineage of M. leprae is still found in some southern states of America.
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Affiliation(s)
- Sarah A. Inskip
- Faculteit Archaeologie, Universiteit Leiden, 2311 BE, Leiden, The Netherlands
| | - G. Michael Taylor
- Department of Microbial and Cellular Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, GU2 7TE, United Kingdom
| | - Sonia R. Zakrzewski
- Department of Archaeology, University of Southampton, Avenue Campus, Highfield, Southampton, SO17 1BF, United Kingdom
| | - Simon A. Mays
- Ancient Monuments Laboratory, English Heritage Centre for Archaeology, Fort Cumberland, Fort Cumberland Road, Eastney, Portsmouth PO4 9LD, United Kingdom
| | - Alistair W. G. Pike
- Department of Archaeology, University of Southampton, Avenue Campus, Highfield, Southampton, SO17 1BF, United Kingdom
| | - Gareth Llewellyn
- EPSRC National Mass Spectrometry Facility, Institute of Mass Spectrometry, College of Medicine, Swansea University, Swansea, SA2 8PP, United Kingdom
| | - Christopher M. Williams
- EPSRC National Mass Spectrometry Facility, Institute of Mass Spectrometry, College of Medicine, Swansea University, Swansea, SA2 8PP, United Kingdom
| | - Oona Y-C Lee
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Houdini H. T. Wu
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - David E. Minnikin
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Gurdyal S. Besra
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Graham R. Stewart
- Department of Microbial and Cellular Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, GU2 7TE, United Kingdom
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Richards LE, Horner ME, Menter A. Resident rounds part III: case report: a papulo- nodular eruption with systemic signs and symptoms. J Drugs Dermatol 2015; 14:422. [PMID: 26043447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This is a typical presentation of erythema nodosum leprosum in a patient with lepromatous leprosy who recently migrated from Micronesia. The clinical presentation, pathology findings, pathogenesis, and therapeutic options are reviewed here.
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Sung SM, Kobayashi TT. Diagnosis and treatment of leprosy type 1 (reversal) reaction. Cutis 2015; 95:222-226. [PMID: 25942024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Leprosy is a chronic granulomatous infection caused by the organism Mycobacterium leprae that primarily affects the skin and peripheral nerves. Leprosy has several distinct clinical presentations ranging from moderate to severe, with the extent of disease generally depending on the host's immune response to the infection. Treatment typically involves antimicrobials (eg, clofazimine, dapsone, rifampin). Once treatment is started, an important aspect of patient care is the recognition of possible reversal reactions. We report the case of a 44-year-old man who repeatedly developed physical findings consistent with a type 1 (reversal) reaction after undergoing multiple treatments for leprosy. A discussion of leprosy along with its clinical manifestations, treatment methods, and management of reversal reactions also is provided.
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Affiliation(s)
- Sarah M Sung
- Johns Hopkins Hospital, Department of Dermatology, 1500 Orleans St, Baltimore, MD 21231, USA
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de Lima Silveira E, de Sousa JR, de Sousa Aarão TL, Fuzii HT, Dias Junior LB, Carneiro FRO, Quaresma JAS. New immunologic pathways in the pathogenesis of leprosy: role for Th22 cytokines in the polar forms of the disease. J Am Acad Dermatol 2015; 72:729-30. [PMID: 25773413 DOI: 10.1016/j.jaad.2014.11.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 11/17/2014] [Accepted: 11/19/2014] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | - Hellen Thais Fuzii
- Nucleo de Medicina Tropical, Universidade Federal do Para, Belem-PA, Brazil
| | | | | | - Juarez Antonio Simões Quaresma
- Nucleo de Medicina Tropical, Universidade Federal do Para, Belem-PA, Brazil; Centro de Ciencias Biologicas e da Saude, Universidade do Estado do Para, Belem-PA, Brazil.
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Goyal T, Varshney A, Bakshi SK, Sharma V. Lymph node abscess and cardiac involvement in a patient with nodular lepromatous leprosy (LL) with erythema nodosum leprosum (ENL): a rare occurrence. LEPROSY REV 2015; 86:112-116. [PMID: 26065155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
With the world's focus on reducing the leprosy patient load to the extent of elimination, finding and reporting the rarer presentations of leprosy becomes important for prompt treatment. Also, these untreated patients may serve as a potential source of infection in community. We report a 35-year old man diagnosed to have lepromatous leprosy and erythema nodosum leprosum with inguinal lymph node abscess and suspected cardiac involvement that proved fatal. We stress the importance of detailed workup to look for associated systemic involvement for timely intervention and favourable outcome.
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Gupta SK, Kaur S, Malhotra V, Arora AK, Sood N, Gupta V. Lepromatous leprosy: An Unusual Presentation. Indian J Lepr 2015; 87:27-32. [PMID: 26591848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 25 year old man presented with loss of sensations over both hands and feet and extreme difficulty in passing urine. On examination, an indurated sclerotic plaque was present on shaft of penis and scrotum in addition to other features of lepromatous leprosy. Skin biopsy from the penile lesion showed presence of a large number of acid fast bacilli with a BI of 6+ extending into the epidermis and histopathology showed absence of Grenz zone and presence of foamy macrophages in the dermis up to the dermo-epidermal junction.
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Berrington WR, Kunwar CB, Neupane K, van den Eeden SJF, Vary JC, Peterson GJ, Wells RD, Geluk A, Hagge DA, Hawn TR. Differential dermal expression of CCL17 and CCL18 in tuberculoid and lepromatous leprosy. PLoS Negl Trop Dis 2014; 8:e3263. [PMID: 25412496 PMCID: PMC4238987 DOI: 10.1371/journal.pntd.0003263] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 09/10/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Leprosy is characterized by polar clinical, histologic and immunological presentations. Previous immunologic studies of leprosy polarity were limited by the repertoire of cytokines known at the time. METHODOLOGY We used a candidate gene approach to measure mRNA levels in skin biopsies from leprosy lesions. mRNA from 24 chemokines and cytokines, and 6 immune cell type markers were measured from 85 Nepalese leprosy subjects. Selected findings were confirmed with immunohistochemistry. PRINCIPAL RESULTS Expression of three soluble mediators (CCL18, CCL17 and IL-10) and one macrophage cell type marker (CD14) was significantly elevated in lepromatous (CCL18, IL-10 and CD14) or tuberculoid (CCL17) lesions. Higher CCL18 protein expression by immunohistochemistry and a trend in increased serum CCL18 in lepromatous lesions was observed. No cytokines were associated with erythema nodosum leprosum or Type I reversal reaction following multiple comparison correction. Hierarchical clustering suggested that CCL18 was correlated with cell markers CD209 and CD14, while neither CCL17 nor CCL18 were highly correlated with classical TH1 and TH2 cytokines. CONCLUSIONS Our findings suggest that CCL17 and CCL18 dermal expression is associated with leprosy polarity.
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Affiliation(s)
- William R. Berrington
- University of Washington School of Medicine, Seattle, Washington, United States of America
- * E-mail:
| | - Chhatra B. Kunwar
- Mycobacterial Research Laboratory, Anandaban Hospital, Kathmandu, Nepal
| | - Kapil Neupane
- Mycobacterial Research Laboratory, Anandaban Hospital, Kathmandu, Nepal
| | | | - James C. Vary
- University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Glenna J. Peterson
- University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Richard D. Wells
- University of Washington School of Medicine, Seattle, Washington, United States of America
| | - Annemieke Geluk
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Deanna A. Hagge
- Mycobacterial Research Laboratory, Anandaban Hospital, Kathmandu, Nepal
| | - Thomas R. Hawn
- University of Washington School of Medicine, Seattle, Washington, United States of America
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Shah A, Mahajan R, Ninama K, Bilimoria F. Annular bullous lesions with atypical erythema multiforme in leprosy. LEPROSY REV 2014; 85:201-207. [PMID: 25509721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Erythema nodosum leprosum (ENL) is an immune complex-mediated reaction that may complicate the course of multibacillary leprosy. Bullous lesions in Type II reaction, though reported, are exceedingly rare. We report the case of a 32 year old female patient who presented initially at our OPD with erythema nodosum. Cutaneous examination revealed impaired sensation over dorsum of right foot and thickened right lateral popliteal nerve. Slit skin smear (SSS) from ear lobes revealed AFB with a bacteriological index of 2+. She was started on MDT, tablet ofloxacin 200 mg twice a day, and 30 mg oral prednisolone. Two months later, she presented with generalised pruritus, large target lesions over the back, and hemorrhagic bullae over lower extremities and annular pattern of bullae, over both arms. A SSS was repeated which was positive for AFB. Histopathology from bullous lesions was consistent with ENL. Direct Immunofluorescence (DIF) study was negative. Our patient improved rapidly after she was started on thalidomide 100 mg twice daily, with withdrawal of ofloxacin. Erythema Multiforme (EMF) and annular bullous lesions have been reported in patients on treatment with ofloxacin. This case is being presented due to the unusual and varied manifestation of Type II lepra reaction in a 34 year old female patient.
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Nunzie E, Ortega Cabrera LV, Macanchi Moncayo FM, Ortega Espinosa PF, Clapasson A, Massone C. Lucio Leprosy with Lucio's phenomenon, digital gangrene and anticardiolipin antibodies. LEPROSY REV 2014; 85:194-200. [PMID: 25509720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Lucio's phenomenon (LPh) is considered a necrotizing panvasculitis and a variant of leprosy Type 2 reaction, clinically characterised by necrotic-haemorrhagic lesions on the extremities and trunk. LPh is observed in diffuse lepromatous leprosy (DLL or Lucio-Latapí leprosy). This is a distinct form of lepromatous leprosy (LL) reported mainly in Mexico. Anti-phospholipid antibody syndrome (APS) has been rarely described in LPh. We report a case of Lucio-Latapí leprosy with LPh observed in a patient from the province of El Oro in Ecuador, who presented clinical manifestations of long standing DLL (non-nodular infiltration of the skin, collapse of the nasal pyramid, madarosis, atrophy of the earlobes), of LPh (necrotic-haemorrhagic macules with irregular shapes) and of APS (necrosis of the right big and second toe). Histopathology showed perineural and periadnexal foamy macrophages with numerous bacilli (diagnostic of LL) in the subcutis, a mild lobular panniculitis with a large subcutaneous vessel infiltrated by macrophages in the wall (typical of LPh) and vessels of the superficial and mid dermis occluded by thrombi but without signs of vasculitis (typical of occlusive vasculopathy as in APS). Our observations suggest that some cases of LPh may be associated with APS. Anti-cardiolipin antibodies (aCL) and lupus anticoagulant (LA) should be tested in patients with LPh because this may have therapeutic implications.
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Curi PF, Villaroel JS, Migliore N, Albertengo A, Aquino ML, Ceccato F, Paira S. Lucio's phenomenon: report of five cases. Clin Rheumatol 2014; 35:1397-401. [PMID: 24863848 DOI: 10.1007/s10067-014-2683-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 05/13/2014] [Accepted: 05/15/2014] [Indexed: 11/25/2022]
Abstract
The different clinical forms of leprosy are mainly related to the variety of immunological responses to the infection. Several forms of lepromatous leprosy are recognized, including macular, nodular, and diffuse. Lucio's phenomenon is a rare but distinctive skin eruption seen in patients with diffuse lepromatous leprosy. The diffuse lesions of Lucio's phenomenon have a predilection for the extremities, can include nodules, and heal with atrophic stellate scars; histologically, a necrotizing vasculitis accompanied by a nonspecific inflammatory reaction may be seen. Because of its rarity and similarity with some manifestations of the rheumatic disease and other causes of vasculitis, Lucio's phenomenon may not be easily recognized, especially in non-endemic countries, which leads to confusing diagnosis and loss of time for treatment. We report five patients with vasculitis caused by Lucio's phenomenon.
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Affiliation(s)
- Pablo Finucci Curi
- Rheumatology Section, Hospital JM Cullen, Av Freyre 2150- (3000), Santa Fe, Argentina
| | - Julieta Solis Villaroel
- Department of Internal Medicine, Hospital Interzonal San Juan Bautista, Catamarca, Argentina
| | - Nora Migliore
- Department of Pathology, Hospital JM Cullen, Santa Fe, Argentina
| | | | | | - Federico Ceccato
- Rheumatology Section, Hospital JM Cullen, Av Freyre 2150- (3000), Santa Fe, Argentina
| | - Sergio Paira
- Rheumatology Section, Hospital JM Cullen, Av Freyre 2150- (3000), Santa Fe, Argentina.
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Sehgal VN, Prasad PVS, Kaviarasan PK, Malhotra S. Lucio's phenomenon and/or relapsing erythema necroticans. Skinmed 2014; 12:103-104. [PMID: 24933849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Aglamis E, Tasdemir C, Yucel MO, Ceylan C, Erden I. Prostatic and testicular parameters in lepromatous patients. LEPROSY REV 2014; 85:48-53. [PMID: 24974442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVES To evaluate PSA (Prostate-specific antigen) parameters in patients with lepromatous leprosy (LL). DESIGN In a retrospective study, 23 male patients with LL were evaluated. PSA parameters (serum total PSA (tPSA), free PSA (fPSA), free-to-total PSA ratio (f/tPSA), PSA Density (PSAD)) were assessed. PSA parameters were compared with a control group. RESULTS The mean tPSA, fPSA, f/tPSA, prostate volume, and PSAD values of the patient group with LL were 1.87 +/- 0.81 ng/ml, 0.67 +/- 0.29 ng/ml, 0.36 +/- 0.11, 41.08 +/- 23.65 ml and 0.055 +/- 0.037, respectively. The mean tPSA, fPSA, f/tPSA, prostate volume, and PSAD values of the control group were 2.71 +/- 0.91 ng/ml, 0.80 +/- 0.34 ng/ml, 0.30 +/- 0.08, 65.0 +/- 28.73 ml and 0.049 +/- 0.028, respectively. The mean tPSA and prostate volume values were found to be significantly lower in the patient group with LL (p = 0.002 and 0.004, respectively). No significant difference was found between two groups in terms of mean fPSA and PSAD values (p = 0.18 and 0.5, respectively). The mean f/tPSA value was found to be significantly higher in the patient group with LL (p = 0.02). Testes in 16 (69%) patients with LL were bilaterally atrophic. CONCLUSIONS Serum tPSA values and prostate volumes in the patients with LL were significantly reduced and f/tPSA values were significantly increased. Testicular atrophy in the lepromatous cases might be due to leprosy-related orchitis and associated with a reduction in prostatic volume.
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Affiliation(s)
- Praveen Kesav
- *Address correspondence to Praveen Kesav, Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India. E-mail:
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44
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Pai VV, Athanikar S, Naveen KN, Sori T, Rao R. Lucio phenomenon. Cutis 2014; 93:E12-E14. [PMID: 24605353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Varadraj V Pai
- Department of Dermatology, Goa Medical College, Goa 403202, India.
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Saini C, Ramesh V, Nath I. Increase in TGF-β secreting CD4⁺CD25⁺ FOXP3⁺ T regulatory cells in anergic lepromatous leprosy patients. PLoS Negl Trop Dis 2014; 8:e2639. [PMID: 24454972 PMCID: PMC3894184 DOI: 10.1371/journal.pntd.0002639] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 12/01/2013] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Lepromatous leprosy caused by Mycobacterium leprae is associated with antigen specific T cell unresponsiveness/anergy whose underlying mechanisms are not fully defined. We investigated the role of CD25(+)FOXP3(+) regulatory T cells in both skin lesions and M.leprae stimulated PBMC cultures of 28 each of freshly diagnosed patients with borderline tuberculoid (BT) and lepromatous leprosy (LL) as well as 7 healthy household contacts of leprosy patients and 4 normal skin samples. METHODOLOGY/PRINCIPLE FINDINGS Quantitative reverse transcribed PCR (qPCR), immuno-histochemistry/flowcytometry and ELISA were used respectively for gene expression, phenotype characterization and cytokine levels in PBMC culture supernatants. Both skin lesions as well as in vitro antigen stimulated PBMC showed increased percentage/mean fluorescence intensity of cells and higher gene expression for FOXP3(+), TGF-β in lepromatous (p<0.01) as compared to tuberculoid leprosy patients. CD4(+)CD25(+)FOXP3(+) T cells (Tregs) were increased in unstimulated basal cultures (p<0.0003) and showed further increase in in vitro antigen but not mitogen (phytohemaglutinin) stimulated PBMC (iTreg) in lepromatous as compared to tuberculoid leprosy patients (p<0.002). iTregs of lepromatous patients showed intracellular TGF-β which was further confirmed by increase in TGF-β in culture supernatants (p<0.003). Furthermore, TGF-β in iTreg cells was associated with phosphorylation of STAT5A. TGF-β was seen in CD25(+) cells of the CD4(+) but not that of CD8(+) T cell lineage in leprosy patients. iTregs did not show intracellular IFN-γ or IL-17 in lepromatous leprosy patients. CONCLUSIONS/SIGNIFICANCE Our results indicate that FOXP3(+) iTregs with TGF-β may down regulate T cell responses leading to the antigen specific anergy associated with lepromatous leprosy.
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Affiliation(s)
- Chaman Saini
- National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
| | - Venkatesh Ramesh
- Department of Dermatology, Safdarjung Hospital, New Delhi, India
| | - Indira Nath
- National Institute of Pathology, Safdarjung Hospital Campus, New Delhi, India
- * E-mail:
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Das T, Ghosh S, Kundu AK, Maity A. Reactional state in lepromatous leprosy simulating Sweet's syndrome. J Assoc Physicians India 2013; 61:856-858. [PMID: 24974510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Erythema nodosum leprosum (ENL) or Type-2 lepra reaction is a manifestation of type-III hypersensitivity response, and usually occurs in certain cases of lepromatous and borderline lepromatous leprosy. ENL may present as widespread crops of erythematous, inflamed nodules and papules. Rare variants of ENL mimicking pemphigus or Sweet's syndrome (SS) have been documented. Here, we report an unusual case of persistent ENL in a 52-year-old lady, which we could diagnose with the help of skin biopsy and histopathological examination.
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47
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Da Costa DAM, Enokihara MMSS, Nonogaki S, Maeda SM, Porro AM, Tomimori J. Wade histoid leprosy: histological and immunohistochemical analysis. LEPROSY REV 2013; 84:176-185. [PMID: 24428111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Histoid leprosy is a rare multibacillary form that presents with disseminated papule-nodular cutaneous lesions. To study the inflammatory infiltrate of the histoid form and to compare it with other lepromatous forms, we performed histological and immunohistochemical analysis on skin biopsies. Fifteen patients were included for histopathological analysis (10 histoid and five lepromatous) via the haematoxylin-eosin and Ziehl-Neelsen-Faraco stains. Thus, immunohistochemical techniques using immunoperoxidase assay were performed for: anti-BCG, anti-M. leprae, anti-CD8, anti-CD3, anti-CD20, anti-S100, anti-CD1a, anti-CD68 and antivimentin. Spindle cells were present in all histoid patients. A pseudocapsule was observed in half of both studied forms. A comparison using the Ziehl-Neelsen-Faraco stain to evaluate anti-BCG and anti-M.leprae showed no major differences. The CD3+ cells were more pronounced in the histoid form than the lepromatous form. There was greater immunoreactivity toward CD8+ cells in the histoid form, as well as the CD20+ cell count. A similar count of S100+ cells in the epidermis of both leprosy forms was observed. There was a slight increase of dendritic cells in the histoid patients in the superficial and deep dermis. For CD1a marker, we observed expression in the epidermis and superficial dermis in both forms. A diffuse and intense infiltrate of CD68+ cells was also observed in the histoid and lepromatous forms. The high positivity for vimentin did not allow for a positive cell count. We concluded that the activation of both the cellular and humoral response is more pronounced in the histoid form because the T and B cells showed greater infiltration than those in the lepromatous form. The activation of dendritic and Langerhans cells is similar in both forms. The spindle cells likely belong to the macrophage population, thus maintaining phagocytic ability. The quantities of pseudocapsules and bacilli are similar and cannot serve as criteria for diagnosis.
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Affiliation(s)
| | | | - Suely Nonogaki
- Pathology Center, Instituto Adolfo Lutz, São Paulo, Brazil
| | - Solange M Maeda
- Department of Dermatology, Escola Paulista de Medicina/UNIFESP, Brazil
| | - Adriana M Porro
- Department of Dermatology, Escola Paulista de Medicina/UNIFESP, Brazil
| | - Jane Tomimori
- Department of Dermatology, Escola Paulista de Medicina/UNIFESP, Brazil
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Prashar A, Narang T, Saikia UN, Dogra S. Deck chair sign in lepromatous leprosy. LEPROSY REV 2013; 84:252-254. [PMID: 24428120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Binitha MP, Saritha S, Riyaz N, Mary V. Pancytopenia due to lepromatous involvement of the bone marrow: successful treatment with multidrug therapy. LEPROSY REV 2013; 84:145-150. [PMID: 24171241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Leprosy is a chronic infectious disease with a wide spectrum of signs and symptoms depending on the ability of the host's immune system to resist the infection. The disease is frequently associated with sensory loss in skin lesions and damage in peripheral nerve trunks leading to nerve function impairment. In lepromatous leprosy, the immune system offers no protection against the multiplying bacilli and this results in heavy infiltration of the internal organs. We report a case of florid lepromatous leprosy with bone marrow suppression due to the disease, presenting with anemia, leukocytopenia and thrombocytopenia. The hematological abnormalities were fully reversed by mutidrug therapy for leprosy. We suggest that infiltration of the bone marrow by Mycobacterium leprae can cause pancytopenia, which can be cured by treatment of the leprosy alone.
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50
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Yang S, Makredes M, O'Donnell P, Levin NA. A case of Hansen Disease presenting as tinea versicolor. Dermatol Online J 2013; 19:7. [PMID: 24021367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 04/14/2013] [Indexed: 06/02/2023] Open
Abstract
Hansen Disease (leprosy) is an infectious disease that targets macrophages and Schwann cells, caused by the acid fast intracellular organism, Mycobacterium leprae. Clinically, it presents with a spectrum of findings that may include hypopigmented macules, erythematous plaques and nodules, and thickened or tender peripheral nerves. The most feared complication is mutilating damage to facial structures or digits resulting from loss of sensation in affected skin. In non-endemic areas, the diagnosis of leprosy is frequently delayed because it may mimic other more common skin conditions. We present a case of borderline/lepromatous leprosy in an otherwise healthy young Brazilian man that was initially diagnosed as tinea versicolor, but did not respond to appropriate treatment. This case highlights the importance of having a high index of suspicion for leprosy in patients from endemic areas who present with lesions that could be consistent with this disease.
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Affiliation(s)
- Shelley Yang
- University of Massachusetts Medical School, Worcester, Massachusetts
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