RESUMO
Background: Leprosy reactions represent immunologically mediated episodes of acute inflammation that, if not diagnosed and treated promptly, can cause irreversible impairment of nerve function and permanent disabilities. A frequent type of reaction experienced by patients with lepromatous leprosy (LL) and borderline lepromatous leprosy (BL) is erythema nodosum leprosum (ENL), an inflammatory complication that may become chronic or recur in multiple episodes. Although ENL is commonly described as a neutrophil-mediated immune disease, the role of neutrophils is not fully understood. In this study, we assess neutrophilic leukocytosis in a retrospective cohort of patients affected by BL or LL leprosy. Materials and methods: A retrospective observational study was performed using data from 146 patients with BL and LL leprosy diagnosed and treated at the Souza Araújo Outpatient Clinic, Fiocruz, Rio de Janeiro, Brazil. Clinical, demographic, and hematological data were extracted from medical records. Skin biopsy samples obtained from patients for ENL diagnosis were used for histopathological evaluations. Results: Most patients were male (75%) and had a reactional episode (85%), of which 65% were ENL. Multiple episodes were common, 55% of the 80 patients with ENL presented more than 2 episodes (average of 2.6 episodes). In treatment-naive BL/LL patients, the median blood neutrophil counts of patients who developed ENL at some points of their disease course were higher than those who did not experience any reaction (median= 4,567 cells/mm3 vs 3,731 cells/mm3 respectively, p=0.0286). A correlation between the increase in median neutrophil counts and ENL severity was confirmed (6,066 cells/mm3 for mild ENL vs 10,243 cells/mm3 for moderate/severe ENL, p=0.0009). A longitudinal assessment was also performed in 34 patients, confirming the neutrophilic leukocytosis (BL/LL: 4896 cells/mm3 vs ENL: 8408 cells/mm3, p<0.0001). Moreover, increased NLR was associated with a greater neutrophilic infiltration in ENL lesions. Conclusion: We demonstrate that ENL episodes in patients affected by leprosy are associated with elevated blood leukocyte and neutrophil counts and an increased NLR. These findings highlight the significant involvement of neutrophils in the ENL immunological/inflammatory process.
Assuntos
Eritema Nodoso , Hanseníase Virchowiana , Leucocitose , Neutrófilos , Humanos , Eritema Nodoso/imunologia , Eritema Nodoso/diagnóstico , Eritema Nodoso/etiologia , Masculino , Estudos Retrospectivos , Feminino , Adulto , Neutrófilos/imunologia , Hanseníase Virchowiana/imunologia , Hanseníase Virchowiana/diagnóstico , Pessoa de Meia-Idade , Adulto Jovem , Idoso , AdolescenteRESUMO
Erythema nodosum (EN) is a common panniculitis characterized by tender erythematous nodules predominantly on the pretibial area and represents a hypersensitivity reaction to multiple triggers. COVID19 infection and vaccination have been associated with EN in the adult population. We report a pediatric case of EN following COVID19 infection and review the literature on COVID19 infection and COVID19 immunization-related EN.
Assuntos
COVID-19 , Eritema Nodoso , Paniculite , Adulto , Humanos , Criança , Eritema Nodoso/diagnóstico , Eritema Nodoso/etiologia , COVID-19/complicaçõesRESUMO
INTRODUCTION: Extraintestinal manifestations (EIMs) are frequent in patients with inflammatory bowel disease (IBD). Our objective is to characterize and determine the prevalence of MEIs in our cohort of patients with IBD. PATIENTS AND METHODS: A retrospective study was carried out in adult patients with IBD at the Pablo Tobón Uribe Hospital in Medellín. Colombia. Articular MEIs, primary sclerosing cholangitis (PSC), both ophthalmological and dermatological, were considered. Absolute and relative frequencies were used. The Chi square test of independence was used to compare 2proportions and the odds ratio (OR) was estimated. RESULTS: Our registry has 759 patients with IBD, 544 present UC (71.6%), 200 CD (26.3%) and 15 unclassifiable IBD (1.9%); 177 patients with IBD (23.3%) presented EIMs, 123 of 544 (22.6%) with UC and 53 of 200 (26.5%) with CD (OR: 0.81, 95% CI: 0.55-1.17, P=0.31). Regarding the type of EIMs, the articular ones were the most frequent (13.5%), more in CD than in UC (20.0 vs. 11.3%, OR 1.94, 95% CI: 1.25-3.00, P=0.0037). Patients with IBD and EIMs used more antibodies against tumor necrosis factor (anti-TNFs), compared to those without EIMs (43.5 vs. 18.5%, OR 3.38, 95% CI: 2.31-4.90, P=0.0001). CONCLUSIONS: The prevalence of EIMs in our cohort is high (23.3%) and the most frequent type is joint. Anti-TNFs are most used when IBD and EIMs coexist. Our study provides valuable information on the association of EIMs and IBD in Latin America.
Assuntos
Doenças Inflamatórias Intestinais/complicações , Distribuição de Qui-Quadrado , Estudos de Coortes , Colite Ulcerativa/complicações , Colite Ulcerativa/epidemiologia , Colômbia/epidemiologia , Doença de Crohn/complicações , Doença de Crohn/epidemiologia , Eritema Nodoso/epidemiologia , Eritema Nodoso/etiologia , Feminino , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Artropatias/epidemiologia , Artropatias/etiologia , Masculino , Razão de Chances , Úlceras Orais/epidemiologia , Úlceras Orais/etiologia , Prevalência , Psoríase/epidemiologia , Psoríase/etiologia , Pioderma Gangrenoso/epidemiologia , Pioderma Gangrenoso/etiologia , Estudos Retrospectivos , Esclerite/epidemiologia , Uveíte/epidemiologia , Uveíte/etiologiaRESUMO
Leprosy reactions are acute immunological events that occur during the evolution of chronic infectious disease causing neural damage and disabilities. A study using blood samples of 17 leprosy reaction patients and 17 reaction-free was carried out by means of associations between antigens, receptors, and expression of cytokines, using path analysis providing new insights into the immunological mechanisms involved in triggering leprosy reactions. Toll-like receptors (TLR) such as TLR1 and TLR2, presented balanced expression in the reaction-free multibacillary (MB) group (TLR1: 1.01 ± 0.23, TLR2: 1.22 ± 0.18; p = 0.267). On the other hand, downgrading type 1 reaction (T1R) (TLR1: 1.24 ± 0.17, TLR2: 2.88 ± 0.37; p = 0.002) and erythema nodosum leprosum (ENL) (TLR1: 1.93 ± 0.17, TLR2: 2.81 ± 0.15; p = 0.004) revealed an unbalance in relation to the expression of these receptors. When the path analysis was approached, it was noted that interleukin 10 (IL-10) expression showed a dependence relation with phenolic glycolipid I (PGL-I) in downgrading T1R (direct effect = 0.503 > residual effect = 0.364), whereas in ENL, such relationship occurred with lipoarabinomannan (LAM) (direct effect = 0.778 > residual effect = 0.280). On the contrary, in the reaction-free leprosy group, interferon-gamma (IFN-γ) levels were dependent on the association between TLR2 and TLR1 (0.8735). The high TLR2 expression associated with IL-10 levels, in the leprosy reaction groups, may be hypothetically related to the formation of TLR2/2 homodimers and/or TLR2/6 heterodimers linked to evasion mechanisms in downgrading reactions and pathophysiology of ENL.
Assuntos
Eritema Nodoso/etiologia , Regulação da Expressão Gênica , Interferon gama/genética , Interleucina-10/genética , Hanseníase/etiologia , Receptor 1 Toll-Like/genética , Receptor 2 Toll-Like/genética , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , Suscetibilidade a Doenças , Eritema Nodoso/diagnóstico , Eritema Nodoso/epidemiologia , Eritema Nodoso/metabolismo , Feminino , Humanos , Interferon gama/metabolismo , Interleucina-10/metabolismo , Hanseníase/diagnóstico , Hanseníase/epidemiologia , Hanseníase/metabolismo , Masculino , Pessoa de Meia-Idade , Modelos Biológicos , Ligação Proteica , Transdução de Sinais , Receptor 1 Toll-Like/metabolismo , Receptor 2 Toll-Like/metabolismo , Adulto JovemRESUMO
Inflammatory bowel disease (IBD), mainly chronic unspecific ulcerative colitis and Crohn's disease have increased in incidence in the last decades. These have multiple extraintestinal manifestations, with those of the skin appearing after the intestinal clinical presentation. These are classified as: granulomatous dermatosis, reactive dermatosis, and those secondary to treatment of IBD, and other dermatosis. This article presents the pathogenesis, clinical approach, treatment and expected evolution of these manifestations.
Assuntos
Colite Ulcerativa/complicações , Doença de Crohn/complicações , Dermatopatias/etiologia , Eritema Nodoso/tratamento farmacológico , Eritema Nodoso/etiologia , Humanos , Incidência , Doenças Inflamatórias Intestinais/complicações , Pioderma Gangrenoso/etiologia , Pioderma Gangrenoso/patologia , Dermatopatias/tratamento farmacológico , Dermatopatias/patologia , Estomatite Aftosa/etiologia , Síndrome de Sweet/etiologia , Síndrome de Sweet/patologiaRESUMO
BACKGROUND: Erythema Nodosum (EN) is an acute nodular erythematous cutaneous eruption. It is presumed to be a hypersensitivity reaction and it may be idiopathic, or occur in association with diverse diseases and medications. AIM: To identify the main etiologies of EN among patients admitted to a medicine service of a clinical hospital. MATERIAL AND METHODS: Analysis of medical records of patients discharged with the diagnosis of EN during a ten years period. Patients were considered to have secondary EN when an underlying condition was found, and to have idiopathic EN when no such condition was found. RESULTS: One hundred twenty nine patients were identified, but 91, aged 38 ± 14 years (86% females) had available clinical information. The etiology was idiopathic in 32% and secondary in 68% of patients. The leading etiologies were post-Streptococcal in 32%, followed by sarcoidosis in 11%, primary tuberculosis in 7%, Mycoplasma infection in 3%, Bartonella infection in 3%, Behçet's syndrome in 2%, inflammatory bowel disease in 2%, drugs in 1% and other etiologies in 8%. Secondary cases of EN had higher levels of C Reactive Protein and leucocytes than idiopathic cases. CONCLUSIONS: The distribution of causes in our study population were similar to those reported in the literature (With smaller proportion of idiopathic), as was the man/woman (1/6) ratio, and the preponderance of cases in winter and spring. Infectious diseases were the leading causes of EN in this group of patients, and a reasonable initial approach in the hospital should include a diligent medical history and physical examination, complete blood count, ESR, titles ASO, PPD tuberculin skin test, chest X-ray or CT scan and, where deemed appropriate, specific autoimmune and infectious serology.
Assuntos
Eritema Nodoso/etiologia , Adolescente , Adulto , Idoso , Eritema Nodoso/diagnóstico , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Background: Erythema Nodosum (EN) is an acute nodular erythematous cutaneous eruption. It is presumed to be a hypersensitivity reaction and it may be idiopathic, or occur in association with diverse diseases and medications. Aim: To identify the main etiologies of EN among patients admitted to a medicine service of a clinical hospital. Material and Methods: Analysis of medical records of patients discharged with the diagnosis of EN during a ten years period. Patients were considered to have secondary EN when an underlying condition was found, and to have idiopathic EN when no such condition was found. Results: One hundred twenty nine patients were identified, but 91, aged 38 ± 14 years (86% females) had available clinical information. The etiology was idiopathic in 32% and secondary in 68% of patients. The leading etiologies were post-Streptococcal in 32%, followed by sarcoidosis in 11%, primary tuberculosis in 7%, Mycoplasma infection in 3%, Bartonella infection in 3%, Behçet’s syndrome in 2%, inflammatory bowel disease in 2%, drugs in 1% and other etiologies in 8%. Secondary cases of EN had higher levels of C Reactive Protein and leucocytes than idiopathic cases. Conclusions: The distribution of causes in our study population were similar to those reported in the literature (With smaller proportion of idiopathic), as was the man/woman (1/6) ratio, and the preponderance of cases in winter and spring. Infectious diseases were the leading causes of EN in this group of patients, and a reasonable initial approach in the hospital should include a diligent medical history and physical examination, complete blood count, ESR, titles ASO, PPD tuberculin skin test, chest X-ray or CT scan and, where deemed appropriate, specific autoimmune and infectious serology.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Eritema Nodoso/etiologia , Estudos Retrospectivos , Eritema Nodoso/diagnóstico , HospitalizaçãoAssuntos
Humanos , Eritema Nodoso/tratamento farmacológico , Hanseníase/complicações , Hanseníase/imunologia , Imunidade Celular , Imunidade Humoral , Neuritos/tratamento farmacológico , Prednisona/uso terapêutico , Talidomida/uso terapêutico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Eritema Multiforme/etiologia , Eritema Nodoso/etiologia , Hanseníase Virchowiana/complicações , Quimioterapia CombinadaRESUMO
INTRODUCTION: Colombia is the country in America with the highest proportion of new cases leprosy with severe disability. To decrease such disability it is necessary to control these reactions, the main cause of nerve damage in leprosy. OBJECTIVE: To describe the clinical and epidemiological characteristics and the treatment of patients with type 1 and 2 leprosy reactions who consulted the Centro Dermatológico Federico Lleras Acosta. MATERIALS AND METHODS: It is a descriptive study which included patients with clinical diagnoses of type 1 and 2 reactions who were seen in the center between 2003 and 2009. The town of origin of the patients, their age, clinical features and treatments were analysed. RESULTS: We studied 96 reactions in 87 patients, 35 type 1 and 61 type 2 reactions; 75% of the patients came from the departments of Tolima, Cundinamarca, Santander and Boyacá; 77% of type 1 reaction occurred before the beginning of multidrug therapy for leprosy. The reactions that started after stopping the multidrug therapy were considered as a leprosy relapse. CONCLUSIONS: Correct identification of type 1 reaction by the general practitioner will allow the diagnosis of leprosy in a large percentage of patients. The type 1 reaction that begins after stopping the leprosy multidrug therapy may be a manifestation of a relapse of the disease.
Assuntos
Eritema Nodoso/epidemiologia , Hanseníase/patologia , Adolescente , Adulto , Idoso , Colômbia/epidemiologia , Citocinas/metabolismo , Quimioterapia Combinada , Eritema Nodoso/etiologia , Feminino , Humanos , Doenças do Complexo Imune/epidemiologia , Doenças do Complexo Imune/etiologia , Hansenostáticos/uso terapêutico , Hanseníase/tratamento farmacológico , Hanseníase/epidemiologia , Hanseníase/fisiopatologia , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/tratamento farmacológico , Hanseníase Virchowiana/epidemiologia , Hanseníase Virchowiana/imunologia , Hanseníase Paucibacilar/tratamento farmacológico , Hanseníase Paucibacilar/patologia , Hanseníase Paucibacilar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Recidiva , Centros de Atenção Terciária/estatística & dados numéricos , Adulto JovemRESUMO
Introducción. Colombia es el país de América con mayor proporción de casos nuevos de lepra con discapacidad grave. Para disminuir tal discapacidad se requiere el control de las reacciones, principal causa del daño neural en esta enfermedad. Objetivo. Describir las características clínicas y epidemiológicas y el tratamiento de los pacientes con reacciones de tipo 1 y 2 que consultaron al Centro Dermatológico Federico Lleras Acosta. Materiales y métodos. Se trata de un estudio descriptivo que incluyó la población de pacientes con diagnóstico clínico de reacciones de tipo 1 y de tipo 2 por lepra, que acudieron al centro entre los años 2003 y 2009. Resultados. Se estudiaron 96 reacciones, 35 del tipo 1 y 61 del tipo 2. El 75 % de los pacientes provenía de los departamentos de Tolima, Cundinamarca, Santander y Boyacá. El 56 % de las reacciones de tipo 1 se presentaron antes de iniciar la poliquimioterapia para la lepra; el dermatólogo tratante consideró que las reacciones que se presentaron después de suspender la poliquimioterapia eran recaídas. El 94 % de las reacciones de tipo 1 se trataron con corticoides orales. El 97 % de los pacientes con reacciones de tipo 2 presentaron eritema nudoso, y todos se trataron con talidomida. Conclusiones.La clínica de la reacción de tipo 1 puede orientar al diagnóstico de la lepra en un paciente sin el antecedente de esta enfermedad (56 %). La reacción de tipo 1 que se inicia después de suspender la poliquimioterapia para la lepra, podría ser una manifestación de recaída de la enfermedad. La reacción de tipo 2 es más frecuente en hombres, con una relación hombre a mujer de 4:1. El 97 % de los pacientes con reacción de tipo 2 presentó eritema nudoso.
Introduction: Colombia is the country in America with the highest proportion of new cases leprosy with severe disability. To decrease such disability it is necessary to control these reactions, the main cause of nerve damage in leprosy. Objective: To describe the clinical and epidemiological characteristics and the treatment of patients with type 1 and 2 leprosy reactions who consulted the Centro Dermatológico Federico Lleras Acosta. Materials and methods: It is a descriptive study which included patients with clinical diagnoses of type 1 and 2 reactions who were seen in the center between 2003 and 2009. The town of origin of the patients, their age, clinical features and treatments were analysed. Results: We studied 96 reactions in 87 patients, 35 type 1 and 61 type 2 reactions; 75% of the patients came from the departments of Tolima, Cundinamarca, Santander and Boyacá; 77% of type 1 reaction occurred before the beginning of multidrug therapy for leprosy. The reactions that started after stopping the multidrug therapy were considered as a leprosy relapse. Conclusions: Correct identification of type 1 reaction by the general practitioner will allow the diagnosis of leprosy in a large percentage of patients. The type 1 reaction that begins after stopping the leprosy multidrug therapy may be a manifestation of a relapse of the disease.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Eritema Nodoso/epidemiologia , Hanseníase/patologia , Colômbia/epidemiologia , Citocinas , Quimioterapia Combinada , Eritema Nodoso/etiologia , Doenças do Complexo Imune/epidemiologia , Doenças do Complexo Imune/etiologia , Hansenostáticos/uso terapêutico , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/tratamento farmacológico , Hanseníase Virchowiana/epidemiologia , Hanseníase Virchowiana/imunologia , Hanseníase Paucibacilar/tratamento farmacológico , Hanseníase Paucibacilar/patologia , Hanseníase Paucibacilar/fisiopatologia , Hanseníase/tratamento farmacológico , Hanseníase/epidemiologia , Hanseníase/fisiopatologia , Recidiva , Centros de Atenção Terciária/estatística & dados numéricosRESUMO
INTRODUCTION: Damage of testicles is frequent in lepromatous leprosy and worsened by the presence of erythema nodosum leprosum. Objective. A patient is presented who developed lepromatous leprosy and erythema nodosum leprosum with major testicular compromise. MATERIAL AND METHODS: The 28-year-old male patient had lepromatous leprosy since age 22. During a polychemotherapy treatment for the lepromatous leprosy, he presented chronic erythema nodosum leprosum that affected both testicles; he did not respond to the conventional treatment. A left orchidectomy was performed to treat the persistent pain. RESULTS: The extracted testis evidenced the following: tubular atrophy, extensive fibrosis, cumulus of foamy macrophages without rods, focal Leydig cell hyperplasia, linfocitary and granulomatous arteritis and endarteritis of small and medium size vessels. These changes were also observed in the epididymis. Two years after the polychemoterapy and the orchidectomy, the patient exhibited azoospermy, normal total testosterone, slightly diminished free testosterone and elevated levels of luteinizing hormone and follicle-stimulating hormone. No loss of libido or sexual activity was reported. General concepts of erythema nodosum leprosum were reviewed, as well as the pathologic changes produced by leprosy in the testis. CONCLUSION: Lepromatous leprosy may lead to hypogonadism. This condition is recommended for inclusion in leprosy diagnostic programs in order to detect and treat the consequences of the possible hypogonadism.
Assuntos
Eritema Nodoso/etiologia , Hipogonadismo/etiologia , Hanseníase Virchowiana/complicações , Doenças Testiculares/etiologia , Adulto , Atrofia , Azoospermia/etiologia , Clofazimina/uso terapêutico , Dapsona/uso terapêutico , Epididimo/patologia , Eritema Nodoso/patologia , Eritema Nodoso/cirurgia , Fibrose , Células Espumosas/patologia , Hormônio Foliculoestimulante/sangue , Humanos , Hiperplasia , Hipogonadismo/sangue , Hansenostáticos/uso terapêutico , Hanseníase Virchowiana/classificação , Hanseníase Virchowiana/tratamento farmacológico , Hanseníase Virchowiana/imunologia , Hanseníase Virchowiana/patologia , Células Intersticiais do Testículo/patologia , Hormônio Luteinizante/sangue , Masculino , Orquiectomia , Rifampina/uso terapêutico , Doenças Testiculares/patologia , Doenças Testiculares/cirurgia , Testosterona/sangue , Talidomida/uso terapêuticoRESUMO
Introducción. La afección testicular es frecuente en la lepra lepromatosa, daño que se incrementa cuando cursa con eritema nudoso leproso. Objetivo. Presentar un paciente con lepra lepromatosa y eritema nudoso leproso con grave compromiso testicular. Materiales y métodos. Se estudió un hombre de 28 años con lepra lepromatosa desde los 22, que durante la poliquimioterapia para la lepra presentó eritema nudoso leproso crónico que afectó ambos testículos y no respondió al manejo convencional. El dolor persistente obligó a practicar orquidectomía izquierda. Resultados. Este testículo presentaba atrofia tubular y fibrosis notorias, conglomerados de macrófagos espumosos, sin bacilos, hiperplasia focal de células de Leydig, endarteritis y arteritis linfocitaria y granulomatosa de vasos pequeños y medianos; estos cambios también estaban presentes en el epidídimo. Un estudio llevado a cabo dos años después de terminar su tratamiento y de la orquidectomía izquierda, demostró azoospermia, testosterona total normal, testosterona libre discretamente disminuida y hormonas lutropina (luteinizante) y folitropina (estimulante del folículo) elevadas. No había disminución de la libido ni de su actividad sexual. Se revisaron los conceptos generales sobre el eritema nudoso leproso y las alteraciones que la lepra produce en el testículo. Conclusión. La lepra lepromatosa puede conducir a hipogonadismo. Los programas de lepra deben contemplar esta complicación para corregir y evitar sus secuelas.
Introduction. Damage of testicles is frequent in lepromatous leprosy and worsened by the presence of erythema nodosum leprosum. Objective. A patient is presented who developed lepromatous leprosy and erythema nodosum leprosum with major testicular compromise. Material and methods. The 28-year-old male patient had lepromatous leprosy since age 22. During a polychemotherapy treatment for the lepromatous leprosy, he presented chronic erythema nodosum leprosum that affected both testicles; he did not respond to the conventional treatment. A left orchidectomy was performed to treat the persistent pain. Results. The extracted testis evidenced the following: tubular atrophy, extensive fibrosis, cumulus of foamy macrophages without rods, focal Leydig cell hyperplasia, linfocitary and granulomatous arteritis and endarteritis of small and medium size vessels. These changes were also observed in the epididymis. Two years after the polychemoterapy and the orchidectomy, the patient exhibited azoospermy, normal total testosterone, slightly diminished free testosterone and elevated levels of luteinizing hormone and follicle-stimulating hormone. No loss of libido or sexual activity was reported. General concepts of erythema nodosum leprosum were reviewed, as well as the pathologic changes produced by leprosy in the testis. Conclusion. Lepromatous leprosy may lead to hypogonadism. This condition is recommended for inclusion in leprosy diagnostic programs in order to detect and treat the consequences of the possible hypogonadism.
Assuntos
Adulto , Humanos , Masculino , Eritema Nodoso/etiologia , Hipogonadismo/etiologia , Hanseníase Virchowiana/complicações , Doenças Testiculares/etiologia , Atrofia , Azoospermia/etiologia , Clofazimina/uso terapêutico , Dapsona/uso terapêutico , Epididimo/patologia , Eritema Nodoso/patologia , Eritema Nodoso/cirurgia , Fibrose , Células Espumosas/patologia , Hormônio Foliculoestimulante/sangue , Hiperplasia , Hipogonadismo/sangue , Hansenostáticos/uso terapêutico , Hanseníase Virchowiana/classificação , Hanseníase Virchowiana/tratamento farmacológico , Hanseníase Virchowiana/imunologia , Hanseníase Virchowiana/patologia , Células Intersticiais do Testículo/patologia , Hormônio Luteinizante/sangue , Orquiectomia , Rifampina/uso terapêutico , Doenças Testiculares/patologia , Doenças Testiculares/cirurgia , Testosterona/sangue , Talidomida/uso terapêuticoRESUMO
Erythema nodosum (EN) is a form of panniculitis, which has been associated with several infectious and noninfectious etiologies. EN clusters have been associated with outbreaks of Coccidioides immitis, Histoplasma capsulatum, and Yersinia pseudotuberculosis infections. In December 2007, a physician in a rural New Mexico community of approximately 10,000 persons reported to the New Mexico Department of Health (NMDOH) that 13 patients had been diagnosed with EN since mid-November. No EN outbreak had ever been detected in this community, and since 2006, only one diagnosis of EN had been made at the local health-care facility. NMDOH initiated an investigation to confirm the existence of the outbreak, determine the underlying etiology, and implement control measures. This report describes the results of that investigation. Twenty-five EN cases were identified. Seventeen of 20 patients who answered a standard questionnaire reported being at a construction site with crowded and dusty conditions before EN onset. Nine of 15 chest radiographs were abnormal. Serologic test results were interpreted as negative for mycotic agents and inconclusive for Mycoplasma pneumoniae infection. No etiology of the outbreak could be found. During an EN outbreak, timely (acute and convalescent) specimen collection (ideally from case-patients and control subjects to determine baseline seropositivity) and sensitive tests (e.g., polymerase chain reaction [PCR]) are essential to differentiate among possible causes of EN.
Assuntos
Surtos de Doenças , Eritema Nodoso/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Eritema Nodoso/etiologia , Arquitetura de Instituições de Saúde , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New Mexico/epidemiologia , População Rural , Manejo de EspécimesRESUMO
INTRODUCTION: Clofazimine enterophathy is a serious complication of clofazimine when used at high doses for treatment of type 2 lepra or or erythema nodosum leprosum. Objective. A woman is presented who had a delayed diagnosis of leprosy, persistent type 2 lepra reaction and lethal clofazimine enteropathy. MATERIALS AND METHODS: A 31-year-old woman presented leprosy symptoms over a 16-year period without medical diagnosis of her disease. During this period, type 2 lepra episodes occurred, but were not accurately diagnosed. These episodes became more severe during her second pregnancy. The patient and her family were interviewed, and her clinical history reviewed. RESULTS: After twelve years of medical consults, lepromatous leprosy was diagnosed, based on perforation of her nasal septum, with a bacterial index of 5. Her husband and a 12-year-old daughter have leprosy symptoms. During multidrug therapy, she presented with repeated type 2 lepra reaction episodes for which she received daily clofazimine 400 mg doses. Two months after this treatment, severe and frequent episodes of intense abdominal pain began to occur. These persisted for more than a year and were managed with in-hospital administration of several classes of painkillers and antispasmodic medication, including morphine. She also presented with sporadic diarrhea, constipation, nausea, weight loss and mesenteric adenopathies. She died finally due to this intestinal condition. No autopsy was performed. CONCLUSIONS: The patient's clinical presentation suggested a clofazimine-induced lethal enteropathy, a complication not previously seen in Colombia. This connection was not recognized by the medical officers that treated the patient.
Assuntos
Clofazimina/efeitos adversos , Erros de Diagnóstico , Eritema Nodoso/etiologia , Enteropatias/induzido quimicamente , Hansenostáticos/efeitos adversos , Hanseníase Virchowiana/complicações , Dor Abdominal/induzido quimicamente , Adulto , Artrite Reumatoide/diagnóstico , Criança , Pré-Escolar , Clofazimina/administração & dosagem , Clofazimina/uso terapêutico , Constipação Intestinal/induzido quimicamente , Diarreia/induzido quimicamente , Quimioterapia Combinada , Saúde da Família , Evolução Fatal , Feminino , Humanos , Leishmaniose Mucocutânea/diagnóstico , Hansenostáticos/administração & dosagem , Hansenostáticos/uso terapêutico , Hanseníase Virchowiana/diagnóstico , Hanseníase Virchowiana/tratamento farmacológico , Masculino , Parestesia/etiologia , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/microbiologia , Rifampina/administração & dosagemRESUMO
The classical manifestations of leprosy are cutaneous and neurological involvement; however, rheumatic manifestations are relatively common during the course of the disease and can be the initial manifestation. Herein are reviewed the clinical features of leprosy, particularly those that may mimic rheumatic diseases.
Assuntos
Hanseníase/complicações , Doenças Reumáticas/etiologia , Eritema Nodoso/etiologia , Eritema Nodoso/patologia , Humanos , Artropatias/etiologia , Hanseníase/patologia , Hanseníase Virchowiana/complicações , Hanseníase Virchowiana/patologiaRESUMO
Os autores fazem uma revisão bibliográfica sobre eritema nodoso, incluindo suas diversas causas, manifestações clínicas, investigação e diagnósticos diferenciais. É enfatizada que eritema nodoso pode ser a manifestação cutânea de uma doença sistêmica, logo, essa situação deve ser afastada
Assuntos
Humanos , Masculino , Feminino , Adulto , Eritema Nodoso/classificação , Eritema Nodoso/diagnóstico , Eritema Nodoso/epidemiologia , Eritema Nodoso/etiologia , Eritema Nodoso/fisiopatologia , Eritema Nodoso/patologia , Eritema Nodoso/terapia , Diagnóstico Diferencial , Paniculite , DermatopatiasRESUMO
Thalidomide is a racemic glutamic acid derivative approved in the US for erythema nodosum leprosum, a complication of leprosy. In addition, its use in various inflammatory and oncologic conditions in being investigated. Thalidomide interconverts between the (R)- and (S)-enantiomers in plasma, with protein binding of 55% and 65%, respectively. More than 90% of the absorbed drug is excreted in the urine and faeces within 48 hours. Thalidomide is minimally metabolised by the liver, but is spontaneously hydrolysed into numerous renally excreted products. After a single oral dose of thalidomide 200mg (as the US-approved capsule formulation) in healthy volunteers, absorption is slow and extensive, resulting in a peak concentration (Cmax) of 1-2mg/L at 3-4 hours after administration, absorption lag time of 30 minutes, total exposure (AUCoo) of 18mg - h/L, apparent elimination half-life of 6 hours and apparent systemic clearence of 10 L/H. Thalidomide pharmacokinetics are best described by a one-comportment model with first-order absorption and elimination. Because of the low solubility of the drug in the gastrointestinal tract, thalidomide exhibits absorption rate-limited pharmacolinetics (the 'flip-flop' phenomenon), with its elimination rate being faster than in absorption rate. The apparent elimination half-life of 6 hours therefore represents absorption, not elimination. The 'true' apparent volume of distribution was estimated to be 16L by use of the faster elimination-rate half-life. Multiple doses of thalidomide 200 mg/day over 21 days cause no change in the pharmacokinetics, with a steady-state Cmax (Cssmax) of 1.2 mg/L. Simulation of 400 and 800 mg/day also shows no accululation, with Css of 3.5 and 6.0 mg/L, respectively. Multiple-dose studies in cancer patients show pharmacokinetics comparable with those in healthy populations at similar dosages. Thalidomide exhibits a dose-proportional increase in AUC at doses from 50 to 400mg. Because of the low solubility of thalidomide Cmax is less than proportional to dose, and tmax is prolonged with increasing dose. Age, sex and smoking have no effect on the pharmacokinetics of thalidomide, and the effect of food is minimal. Thalidomide does not alter the pharmacokinetics of oral contraceptives, and is also unlikely to interact with warfarin and grapefruit juice. Since thalidomide is mainly hydrolysed and passively excreted, its pharmacokonetics are not expected to change in patients with impaired liver...
Assuntos
Humanos , Talidomida , Talidomida/administração & dosagem , Talidomida/farmacocinética , Talidomida/história , Talidomida/isolamento & purificação , Talidomida/metabolismo , Talidomida/normas , Talidomida/síntese química , Talidomida/toxicidade , Talidomida/uso terapêutico , Administração Oral , Cimetidina/antagonistas & inibidores , Diltiazem/antagonistas & inibidores , Eritema Nodoso/etiologia , Fenobarbital/antagonistas & inibidores , Interações Medicamentosas/fisiologia , Rifampina/antagonistas & inibidores , Síndrome de Imunodeficiência Adquirida Felina/terapia , Varfarina/antagonistas & inibidoresRESUMO
El lupus eritematoso (LE) es una enfermedad multisistémica de patogenia autoinmune. Las manifestaciones cutáneas en el LE son frecuentes -estudios en grandes cohortes han estimado que se presentan en más del 65 por ciento de los casos- y se las clasifica en: 1. Lesiones específicas: a) LE cutáneo agudo (eritema malar, fotosensibilidad, etc.). b) LE cutáneo subagudo (LESA). c) LE cutáneo crónico (p. ej., LE discoide, paniculitis lúpica, etc.). 2. Lesiones inespecíficas: Por ejemplo, vasculitis, livedo reticularis, etc. Objetivo. El propósito del presente trabajo es determinar la incidencia de las diversas manifestaciones cutaneomucosas en pacientes con LE y ordenar las características consideradas desde un punto de vista estadístico. Material y métodos. Entre 1983 y 1997, en el Hospital "J. A. Fernández" de Buenos Aires, se realizó el diagnóstico, control y seguimiento retrospectivo de 91 pacientes con lupus eritematoso sistémico (87 mujeres y 4 hombres). Resultados. Del total de pacientes estudiados, el eritema malar (en alas de mariposa) fue la manifestación más frecuente de lupus. Las lesiones inespecíficas, como el eritema nudoso, las telangiectasias y otras lesiones vasculíticas, tuvieron menor incidencia. Hubo un claro predominio del sexo femenino y la edad de aparición de la enfermedad osciló entre los 20 y los 48 años. Destacamos la importancia del examen dermatológico en la búsqueda e identificación de lesiones cutáneas de LE en todas sus formas, como herramienta para un correcto diagnóstico, seguimiento y tratamiento de los pacientes afectados (AU)
Assuntos
Humanos , Masculino , Feminino , Lúpus Eritematoso Sistêmico/diagnóstico , Estudos Retrospectivos , Lúpus Eritematoso Cutâneo/diagnóstico , Lúpus Eritematoso Discoide/diagnóstico , Transtornos de Fotossensibilidade/etiologia , Alopecia/etiologia , Úlceras Orais/etiologia , Doença de Raynaud/etiologia , Vasculite/etiologia , Púrpura/etiologia , Dermatopatias Vasculares/etiologia , Úlcera Cutânea/etiologia , Urticária/etiologia , Telangiectasia/etiologia , Eritema Nodoso/etiologiaRESUMO
A pilot study has been undertaken to compare the efficacy of small dose pulsed betamethasone therapy with need based oral steroids in chronic recurrent erythema nodosum leprosum (ENL) patients. Though this mode of therapy was well tolerated, no advantage with intermettnt steroid administration was observed. This coul have been on account of small dose of steroid given monthly. Treatment of chronic recurrent erythema nodosum leprosum (ENL) patients continues to be unsatisfactory, particularly, because of non-availability of thalidomide. Though corticosteroids are effective in suppressing all the manifestations and even restoring partially or fully the functional impairment, their side effects and dependence are equally troublesome. Based on (a) the reported efficacy and safety of intermittent use of corticosteroids in several immune complex mediated disorders (Cathcart et al 1976, Kimberly et al 1979), Lieblin et al 1981 and Pasricah & Gupta 1984) and (b) ENL (type II) reactions having similar pathology, a pilot study has been undertaken to see the efficacy and the tolerance of pulsed steroids in chronic ENL patients