Lepromatous Leprosy with Erythema Nodosum Leprosum Presenting As
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Chapter 3 Bacterial and Viral Infections
GBB03 10/4/06 12:20 PM Page 19 Chapter 3 Bacterial and viral infections A mighty creature is the germ gain entry into the skin via minor abrasions, or fis- Though smaller than the pachyderm sures between the toes associated with tinea pedis, His customary dwelling place and leg ulcers provide a portal of entry in many Is deep within the human race cases. A frequent predisposing factor is oedema of His childish pride he often pleases the legs, and cellulitis is a common condition in By giving people strange diseases elderly people, who often suffer from leg oedema Do you, my poppet, feel infirm? of cardiac, venous or lymphatic origin. You probably contain a germ The affected area becomes red, hot and swollen (Ogden Nash, The Germ) (Fig. 3.1), and blister formation and areas of skin necrosis may occur. The patient is pyrexial and feels unwell. Rigors may occur and, in elderly Bacterial infections people, a toxic confusional state. In presumed streptococcal cellulitis, penicillin is Streptococcal infection the treatment of choice, initially given as ben- zylpenicillin intravenously. If the leg is affected, Cellulitis bed rest is an important aspect of treatment. Where Cellulitis is a bacterial infection of subcutaneous there is extensive tissue necrosis, surgical debride- tissues that, in immunologically normal individu- ment may be necessary. als, is usually caused by Streptococcus pyogenes. A particularly severe, deep form of cellulitis, in- ‘Erysipelas’ is a term applied to superficial volving fascia and muscles, is known as ‘necrotiz- streptococcal cellulitis that has a well-demarcated ing fasciitis’. This disorder achieved notoriety a few edge. -
Dermatology DDX Deck, 2Nd Edition 65
63. Herpes simplex (cold sores, fever blisters) PREMALIGNANT AND MALIGNANT NON- 64. Varicella (chicken pox) MELANOMA SKIN TUMORS Dermatology DDX Deck, 2nd Edition 65. Herpes zoster (shingles) 126. Basal cell carcinoma 66. Hand, foot, and mouth disease 127. Actinic keratosis TOPICAL THERAPY 128. Squamous cell carcinoma 1. Basic principles of treatment FUNGAL INFECTIONS 129. Bowen disease 2. Topical corticosteroids 67. Candidiasis (moniliasis) 130. Leukoplakia 68. Candidal balanitis 131. Cutaneous T-cell lymphoma ECZEMA 69. Candidiasis (diaper dermatitis) 132. Paget disease of the breast 3. Acute eczematous inflammation 70. Candidiasis of large skin folds (candidal 133. Extramammary Paget disease 4. Rhus dermatitis (poison ivy, poison oak, intertrigo) 134. Cutaneous metastasis poison sumac) 71. Tinea versicolor 5. Subacute eczematous inflammation 72. Tinea of the nails NEVI AND MALIGNANT MELANOMA 6. Chronic eczematous inflammation 73. Angular cheilitis 135. Nevi, melanocytic nevi, moles 7. Lichen simplex chronicus 74. Cutaneous fungal infections (tinea) 136. Atypical mole syndrome (dysplastic nevus 8. Hand eczema 75. Tinea of the foot syndrome) 9. Asteatotic eczema 76. Tinea of the groin 137. Malignant melanoma, lentigo maligna 10. Chapped, fissured feet 77. Tinea of the body 138. Melanoma mimics 11. Allergic contact dermatitis 78. Tinea of the hand 139. Congenital melanocytic nevi 12. Irritant contact dermatitis 79. Tinea incognito 13. Fingertip eczema 80. Tinea of the scalp VASCULAR TUMORS AND MALFORMATIONS 14. Keratolysis exfoliativa 81. Tinea of the beard 140. Hemangiomas of infancy 15. Nummular eczema 141. Vascular malformations 16. Pompholyx EXANTHEMS AND DRUG REACTIONS 142. Cherry angioma 17. Prurigo nodularis 82. Non-specific viral rash 143. Angiokeratoma 18. Stasis dermatitis 83. -
Leprosy – Eliminated and Forgotten: a Case Report Shiva Raj K.C.1,5* , Geetika K.C.1, Purnima Gyawali2, Manisha Singh3 and Milesh Jung Sijapati4
K.C. et al. Journal of Medical Case Reports (2019) 13:276 https://doi.org/10.1186/s13256-019-2198-1 CASE REPORT Open Access Leprosy – eliminated and forgotten: a case report Shiva Raj K.C.1,5* , Geetika K.C.1, Purnima Gyawali2, Manisha Singh3 and Milesh Jung Sijapati4 Abstract Background: Leprosy is a disease that was declared eliminated in 2010 from Nepal; however, new cases are diagnosed every year. The difficulty arises when the presentation of the patient is unusual. Case presentation: In this case report we present a case of a 22-year-old Tamang man, from the Terai region of Nepal, with a clinical presentation of fever, malaise, and arthralgia for the past 2 weeks with hepatosplenomegaly and bilateral cervical, axillary, and inguinal lymphadenopathy. Features of chronic inflammation with elevated erythrocyte sedimentation rate of 90 mm/hour and liver enzymes were noted. With no specific investigative findings, a diagnosis of Still’s disease was made and he was given prednisolone. On tapering the medication, after 2 weeks, the lymphadenopathy and fever reappeared. On biopsy of a lymph node, diagnosis of possible tuberculosis was made. On that basis anti-tuberculosis treatment category I was started. During his hospital stay, our patient developed nodular skin rashes on his shoulder, back, and face. The biopsy of a skin lesion showed erythema nodosum leprosum and he was diagnosed as having lepromatous leprosy with erythema nodosum leprosum; he was treated with anti-leprosy medication. Conclusion: An unusual presentations of leprosy may delay its prompt diagnosis and treatment; thus, increasing morbidity and mortality. -
Lepromatous Leprosy Simulating Sweet Syndrome
ISSN: 2469-5750 Zemmez et al. J Dermatol Res Ther 2018, 4:056 DOI: 10.23937/2469-5750/1510056 Volume 4 | Issue 1 Journal of Open Access Dermatology Research and Therapy CASE REPORT Lepromatous Leprosy Simulating Sweet Syndrome Youssef Zemmez1*, Ahmed Bouhamidi1, Salwa Belhabib2, Rachid Frikh1, Mohamed Boui1 1 and Naoufal Hjira Check for updates 1Department of Dermatology-Venereology, Mohammed V Military Training Hospital, Rabat, Morocco 2Department of Pathological Anatomy, Mohammed V Military Training Hospital, Rabat, Morocco *Corresponding author: Youssef Zemmez, Department of Dermatology-Venereology, Mohammed V Military Training Hospital, Rabat, Morocco, Tel: 0658150805, E-mail: [email protected] Abstract Leprosy or Hansen's disease is an infection by Mycobac- terium leprae (M. leprae), whose prevalence has consid- erably decreased since the application of the new anti-lep- rosy strategies advocated since 1982 by the World Health Organization (WHO). However, in the endemic countries several cases of leprosy are reported annually. We report a clinical case of lepromatous leprosy revealed by dissemi- nated maculopapular lesions simulating a Sweet syndrome highlighting the importance of knowing how to evoke this diagnosis in patients from endemic areas. Keywords Lepromatous leprosy, Rash, Sweet syndrome Introduction Lepromatous leprosy is generally manifested by Figure 1: a) Maculopapular erythematous lesions of the non-inflammatory lesions, hypochromic macules, and face; b) Papulonodular erythematous lesions in forearms progressive erythematous papulo-nodules. We report and hands. an observation of lepromatous leprosy in a 62-year-old patient from rural Morocco who was diagnosed with abdomen (Figure 2a and Figure 2b). The neurological maculopapular lesions. examination showed hypoesthesia in gloves and socks, with bilateral hypertrophy of the ulnar nerve. -
Leprosy' Revi"Ew
LEPROSY' REVI"EW lbe QD8rterIy Publication of THE BRITISH LEPROSY RELIEF ASSOCIAll0N VOL. XXVIII. No 3. JULY 1957 Principal Contents EditoriaIs Secondary Infections and Neoplasms in Leprosy Patients. Leprosy of the Eye. Thiosemicarbazone in the Treatment of the Reactional and Bordeline Forms of Leprosy. Some Data on the Influence of B.C.G. Vaccination in Leprosy Patients. Abstracts 8 PORTMAN STREET, LONDON, W.l Price: Three Shillings and Sixpence, plus posfage Annual Subscripfion: Fiffeen Shillings, including posfage LEPROSY REVIEW VOL. XXVIII, No. 3. JULY, 1957 CONTENTS PAGE Editorials: Corticosteroids in Leprosy 91 Is there a place for hypnotherapy in leprosy treatment? 92 Secondary Infections and Neoplasms in Leprosy Patients FELIX CONTRERAS 95 Leprosy of the Eye .. W. ]. HOLMES 108 Thiosemicarbazone in the Treatment of the Reactional and Borderline Forms of Leprosy H. W. WHEATE 124 Some Data on the Influence of BCG Vaccination in Leprosy Patients ]. VAN DE HEYNING 130 Abstracts 131 Edited by DR. J. Ross INNES, Medical Secretary of the British Leprosy Relief Association, 8 Portman Street, London, W.l, to whom all communications should be sent. The Association does not accept responsibilty for views expressed by writers. Contributors of original articles will receive 25 loose reprints free, but more formal bound reprints must be ordered at time of submitting the article, and the cost reimbursed later. THE ONE DOSE REMEDY , ANTEPAR ' is such a simple and practical ascarifuge, it enables you to tackle tbe roundworm problem on a large scale. You simply givc each adult or child onc dosc of 'A TEPAR' }!'Iixir. 0 purging, fasting or dieling is necessary. -
Leprosy in Two Patients with Relapsing Remitting Multiple Sclerosis Treated with Fingolimod Alfred Balasa, M.D.1 and George J
Leprosy in Two Patients with Relapsing Remitting Multiple Sclerosis Treated with Fingolimod Alfred Balasa, M.D.1 and George J. Hutton, M.D.2 1 Department of Pediatrics, Section of Pediatric Neurology and Developmental Neuroscience; 2 Department of Neurology; Baylor College of Medicine, Houston, Texas Background A B Leprosy (Hansen’s disease) is a chronic infection caused by Mycobacterium leprae. The disease develops over months to years and may cause extensive damage to the skin and peripheral nervous system. A B In multiple sclerosis (MS), fingolimod treatment is Figure 3. Immune response in the polar clinical forms of leprosy. known to increase the risk for infections. There is one prior reported case of leprosy while on [A] In tuberculoid leprosy (TT) patients, the innate immune response is activated by M. leprae through toll-like receptors (TLR2/1). IL-15 fingolimod for relapsing remitting multiple sclerosis stimulates the vitamin D-dependent antimicrobial program in macrophages and inhibits phagocytosis of mycobacteria. These events (RRMS). We report two further cases of leprosy in promote a Th1 T-cell cytokine response (IFN-γ, IL-2, TNF, and IL-15) that contains the infection in well-formed granulomas, and a Th17 patients with RRMS and treated with fingolimod. C D response (IL-17A, IL-17F, IL-21 and IL-22) that leads to tissue inflammation and destruction, neutrophil recruitment, macrophage activation, and enhancement of Th1 effector cells. [B] In lepromatous leprosy (LL) patients, IL-4, IL-10, leukocyte immunoglobulin-like receptor subfamily A member 2 (LILRA2), and oxidized phospholipids inhibit TLR2/1-induced cytokine responses but preserve IL-10 release. -
Lepromatous Leprosy Masquerading As Rhinophyma
International Journal of Otorhinolaryngology and Head and Neck Surgery Krishna S et al. Int J Otorhinolaryngol Head Neck Surg. 2015 Jul;1(1):34-36 http://www.ijorl.com pISSN 2454-5929 | eISSN 2454-5937 DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20150585 Case Report Lepromatous leprosy masquerading as rhinophyma 1 1 1 2 Sowmyashree Krishna *, Malcolm Pinto , Manjunath Mala Shenoy , Mahesh SG 1 Department of Dermatology, Yenepoya Medical College, Yenepoya University, Mangalore, Karnataka, India 2Department of Otolaryngology-Head and Neck Surgery, A.J. Institute of Medical Sciences and Research Center, Mangalore, Karnataka, India Received: 26 May 2015 Accepted: 24 June 2015 *Correspondence: Dr. Sowmyashree Krishna, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Leprosy a major global health problem, especially in the developing world, is an infectious disease caused by Mycobacterium leprae. Leprosy has a predilection to with cooler areas of the body. Lepromatous leprosy presents with varied manifestations like nodules, cervical lymphadenitis, hyperpigmented patches and other presentations which can mimic various other diseases and pose a diagnostic challenge in endemic areas. We report a case presenting with nodular infiltration of the nose mimicking rhinophyma who presented with faint reddish swelling over the nose which progressed to nodular infiltration. There was bilateral symmetrical thickening of nerves following which diagnosis was confirmed by slit skin smear and the patient was started on multibacillary multidrug therapy. -
Erythema Nodosum (En)
Buffalo Medical Group, P.C. Robert E. Kalb, M.D. Phone: (716) 630-1102 Fax: (716) 633-6507 Department of Dermatology 325 Essjay Road Williamsville, New York 14221 ERYTHEMA NODOSUM (EN) Erythema Nodosum (EN) is a relatively uncommon reaction in the skin consisting of red shiny tender nodular lesions most commonly found on the legs. The erythema refers to the red color that is seen at the surface of the skin. The nodosum refers to the fact that these lesions feel like bumps or nodules underneath the skin surface. Erythema nodosum is a reaction pattern occurring in the subcutaneous tissue and fat. It may be preceded by a low grade fever, fatigue, and joint pains. In about half of the cases, there is an internal condition occurring in the body which contributes to its formation. These include the use of certain medications, certain infections, and a number of other less likely causes. In order to identify cause for the erythema nodosum, it may be necessary to perform blood and laboratory tests. At times, however, the cause cannot be determined and erythema nodosum is considered to be idiopathic in nature. Erythema nodosum often runs an acute course lasting for a brief period from weeks to months. In a small percentage of cases, it can be a more chronic condition. The red nodules are usually confined to the lower legs, but can develop anywhere there is fat under the skin including the thighs, arms, and trunk. Initially, the lesions are more red and inflamed in appearance, but with time become more bruise like. -
Histopathological Study of Dermal Granuloma Gunvanti B
https://ijmsweb.com Indian Journal of Medical Sciences Original Article Histopathological study of dermal granuloma Gunvanti B. Rathod1, Pragnesh Parmar2 1Departments of Pathology, 2Forensic Medicine, GMERS Medical College, Vadnagar, Gujarat, India. ABSTRACT Introduction: The objectives of this study were to confirm the diagnosis of clinically suspected dermal granuloma- tous diseases by histopathological examination and by routine and special stains as well as to study the incidence of various types of dermal granulomas. *Corresponding author: Materials And Methods: This study was conducted at the Department of Pathology in collaboration with De- partment of Skin and Venereal disease. A total of 90 cases from outdoor patient department of skin and venereal Dr. Gunvanti Rathod, disease, which were clinically diagnosed as suspected dermal granulomatous diseases, were taken as the study Departments of Pathology, population. GMERS Medical College, Vadnagar, Gujarat, India. Results: In our study, we found that leprosy had the highest incidence (50%), followed by cutaneous tuberculosis (30%) among all dermal granulomatous diseases like syphilis, fungal, granuloma annulare, foreign body, actino- [email protected] mycosis, and sarcoidosis. Dermal granulomas were most common in middle age between 21 and 40 years of age. Received : 18 September 19 Conclusion: Histopathology played an important role in the final diagnosis of dermal granulomatous lesions. Most common dermal granulomatous disease was leprosy, followed by cutaneous tuberculosis. -
MYELOPATHY ASSOCIATED with SYSTEMIC LUPUS ERYTHEMATOSUS (Erythema Nodosum)
Paraplegia 16 (1978-79) 282-294 Original Articles MYELOPATHY ASSOCIATED WITH SYSTEMIC LUPUS ERYTHEMATOSUS (Erythema Nodosum) L. S. KEWALRAMANI, M.D., M.S.Orth., S. SALEEM, M.D. and D. BERTRAND, M.T. (ASCP) Texas Institute for Rehabilitation and Research and Department of Pathology, Baylor College of Medicine, Houston, Texas 77030, U.S.A. Abstract. Two patients with sudden onset of myelopathy associated with Systemic Lupus Erythematosus (Erythema Nodosum) are described. Pertinent literature is extensively reviewed and these two new patients are added to previously reported 26 patients. Key words: Myelopathy; Meningoencephalomyelopathy; Systemic lupus erythematosus. NEUROLOGICAL manifestations of systemic lupus erythematosus (SLE) have only recently been emphasised although they were mentioned by Kaposi in 1875, who observed stupor and coma as terminal manifestations of the disease. But focal neurological abnormalities were first reported by Osler (1903) and since then there have been several reports in the literature. Most commonly reported entities have been acute organic brain syndrome, seizures and cerebrovascular disorders. Chorea, Guillain Barre syndrome, subarachnoid haemorrhage, peripheral neuro pathy and cranial nerve palsies associated with SLE have also been reported on a few occasions. Myelopathy, however, has not received adequate emphasis as a complication of SLE. Fisher and Gilmour reported the first case of flaccid paraplegia in a female with SLE in 1939. Since then only 25 additional cases have been reported in the medical literature over the past 38 years. Twenty cases have been described in sufficient detail and six briefly, to permit a meaningful review of the spinal cord involvement in this disease. We feel that there are probably many more unreported cases of myelopathy associated with SLE. -
Diagnosis, Classification, and Management of Erythema
Arch Dis Child 2000;83:347–352 347 Diagnosis, classification, and management of Arch Dis Child: first published as 10.1136/adc.83.4.347 on 1 October 2000. Downloaded from erythema multiforme and Stevens–Johnson syndrome C Léauté-Labrèze, T Lamireau, D Chawki, J Maleville, A Taïeb Abstract become widely accepted that EM and SJS, as Background—In adults, erythema multi- well as toxic epidermal necrolysis, are all part of forme (EM) is thought to be mainly a single “EM spectrum”. In both EM and SJS, related to herpes infection and Stevens– pathological changes in the earliest skin lesion Johnson syndrome (SJS) to drug reac- consist of the accumulation of mononuclear tions. cells around the superficial dermal blood Aims—To investigate this hypothesis in vessels; epidermal damage is more characteris- children, and to review our experience in tic of EM with keratinocyte necrosis leading to the management of these patients. multilocular intraepidermal blisters.5 In fact, Methods—A retrospective analysis of 77 there is little clinical resemblance between paediatric cases of EM or SJS admitted to typical EM and SJS, and recently some authors the Children’s Hospital in Bordeaux be- have proposed a reconsideration of the “spec- tween 1974 and 1998. trum” concept and a return to the original Results—Thirty five cases, inadequately description.15–17 According to these authors, the documented or misdiagnosed mostly as term EM should be restricted to acrally urticarias or non-EM drug reactions were distributed typical targets or raised oedema- excluded. Among the remaining 42 pa- tous papules. Depending on the presence or tients (14 girls and 28 boys), 22 had EM (11 absence of mucous membrane erosions the EM minor and 11 EM major), 17 had SJS, cases may be classified as EM major or EM 16 and three had isolated mucous membrane minor. -
Immunological Aspects of Leprosy with Special Reference to Autoimmune Diseases 0
'Bull. Org. mond. Sante 1969, 41, 793-804 Bull. Wld Hlth Org. Immunological Aspects of Leprosy with Special Reference to Autoimmune Diseases 0. WAGER1 Leprosy, particularly lepromatous leprosy, is associated with a multitude of (auto) immune aberrations, and its clinical features also have much in common with the collagen diseases. Immunopathological studies of the 2 groups of diseases may thus elucidate the basic mechanisms of both. The reported evidencefor a genetically determined hyporeactivity ofcell-mediated (CM) immunity in lepromatous subjects is reviewed; most, but not all, of the findings fit such a hypothesis well. The possibility remains that the observed hyporeactivities may be secondary to direct effects of Mycobacterium leprae. Evidencefor a general hyperreactivity of the antibody-mediated (AM) immunity in lepromatous leprosy is then reviewed and considered to be fragmentary. The concept and general criteria of autoimmunity are discussed briefly and the high incidence in lepromatous leprosy of various (auto)immune aberrations, resembling those in systemic lupus erythematosus (SLE) and in rheumatoid arthritis is reviewed. Although autoantibodies are not likely to be directly deleterious to the host, immune complexes containing autoantibodies may be pathogenic. Mixed cryoimmunoglobulins, consisting of 2 (IgG-IgM or IgG-IgA) or 3 immunoglo-. bulins, and occasionally also containing measurable amounts of complement components, have recently been encountered in SLE and its variants and also in a number of microbial diseases with autoimmune features (syphilis, streptococcal nephritis and endocarditis, mononucleosis, Mycoplasma pneumoniae pneumonia). They may represent circulating immune complexes, analogous to the IgM (IgA) rheumatoid factors in combination with their IgG reactants. In leprosy also, the existence of pathogenic immune complexes is indirectly suggested by mixed cryoglobulinemia andfurther by a number of other features reviewed in this article.