RESUMEN
Leprosy still is an important public health problem in several parts of the world including Brazil. Unlike the diseases caused by other mycobacteria, the incidence and clinical presentation of leprosy seems little affected in immunosuppressed patients. We report the first case, to our knowledge, of a liver transplant patient who developed multi-bacillary leprosy. The patient presented with papules and infiltrated plaques with loss of sensation suggestive of leprosy 3.5 years after living-related liver transplantation for autoimmune hepatitis. A skin biopsy showing non-caseating macrophagic granulomas, neuritis, and intact acid-fast bacilli on Fite-Faraco stain, confirmed the diagnosis of borderline lepromatous leprosy. The donor of the liver did not show any evidence of leprosy. During follow-up, the patient presented 2 episodes of upgrading leprosy type I reactions, 1 mild before leprosy treatment, and 1 moderate 3 months after receiving standard multi-drug treatment (rifampicin, clofazimine, and dapsone). These reactions were accompanied by increase in liver function tests, especially of canalicular enzymes. This reaction occurred despite the patient's triple immunosuppression regimen. The moderate reaction was successfully treated with further immunosuppression (prednisone, 0.5 mg/kg). Currently, the patient is asymptomatic, off leprosy medication, with routine liver transplant follow-up. The dilemmas in diagnosis and management of such a case are discussed and the literature on leprosy in transplant recipients is reviewed.
Asunto(s)
Glucocorticoides/uso terapéutico , Leprostáticos/uso terapéutico , Lepra Multibacilar/diagnóstico , Lepra Multibacilar/tratamiento farmacológico , Trasplante de Hígado/efectos adversos , Mycobacterium leprae/efectos de los fármacos , Clofazimina/uso terapéutico , Quimioterapia Combinada , Humanos , Terapia de Inmunosupresión , Lepra Multibacilar/microbiología , Lepra Multibacilar/patología , Masculino , Persona de Mediana Edad , Mycobacterium leprae/aislamiento & purificación , Prednisona/uso terapéutico , Piel/microbiología , Piel/patología , Resultado del TratamientoRESUMEN
Acute methemoglobinemia is an uncommon but potentially treatable disorder in witch patient can present with dramatic signs and symptoms. The early diagnostic and treatment are essentials to prevent this fatal medicine reaction.
Asunto(s)
Humanos , Femenino , Adulto , Dapsona/efectos adversos , Lepra/complicaciones , Metahemoglobinemia/etiología , Metahemoglobinemia/inducido químicamente , Metahemoglobinemia/diagnósticoRESUMEN
Two case reports of patients with human immunodeficiency virus type 1 (HIV-1) infection who developed leprosy are presented. Both developed type 1 leprosy reactions in the absence of antiretroviral therapy. Reactions have been described for a number of HIV-1- and Mycobacterium leprae-coinfected patients and have been considered to be part of an immune reconstitution inflammatory syndrome (IRIS) since the reactions were usually linked to the administration of highly active antiretroviral therapy. The reports of our two patients suggest that the type 1 reactions in patients with leprosy and HIV may not always be an IRIS manifestation but may be akin to the classical reactional state described for the natural course of leprosy infection, which occurs in leprosy patients due to the fluctuations of the antimycobacterial immune response, whether they are coinfected with HIV or not.
Asunto(s)
Infecciones por VIH/complicaciones , VIH-1 , Lepra/inmunología , Adulto , Fármacos Anti-VIH/uso terapéutico , Brasil , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/inmunología , Histocitoquímica , Humanos , Leprostáticos/uso terapéutico , Lepra/complicaciones , Lepra/microbiología , Lepra/patología , Masculino , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/inmunología , Piel/patologíaRESUMEN
We report a patient with discoid lupus erythematosus (DLE) and associated allergic contact dermatitis (ACD) in the eyelids. In women, ACD caused by nail varnish is frequent and often seen in the eyelids. ACD caused by drugs (e.g. neomycin) is also frequent in this region. However, DLE with periorbital presentation without evidence of systemic or other cutaneous involvement is rare.