RESUMO
Trauma can trigger the onset of some lesions of cutaneous leishmaniasis (CL). In this study, we present the case of a 65-year-old man who developed persistent, ulcerative, nodular lymphangiitis at the site of elbow abrasions from a fall during a trip to northeastern Brazil. Skin and lymph node biopsy showed tuberculoid granulomatous inflammation and Grocott-methamine silver-positive yeast forms consistent with Sporothrix and Staphylococcus lugdunensis was identified from tissue culture. Antibacterial and antifungal treatment produced short-term healing. Crusted papules recurred at the sites of injury 3 months later and persisted despite therapy. After 15 months, two punch biopsies showed scarring and granulomatous inflammation; cultures and histochemical stains were negative for microorganisms. Because of refractory disease, multiple polymerase chain reaction (PCR) assays for infectious agents on DNA extracted from the biopsy specimens were performed, and Leishmania guyanensis was detected in all specimens. The patient refused pentavalent antimonial therapy and elected for excision of the CL lesions. After 2 years of follow up, he is without disease. CL should be considered in the differential diagnosis in patients who present with ulcerative, nodular lymphangiitis; have a history of travel to endemic regions; and describe a traumatic insult to the affected region. PCR methods for infectious agents increase the sensitivity and specificity of detecting causative agents in these patients who are negative by routine methods. In some, leishmaniasis may be an occult infection whose presence is heralded by trauma. Coinfection, by altering the immune response, may have facilitated the clinical acquisition of CL.
Assuntos
Leishmaniose Mucocutânea/patologia , Pele/lesões , Pele/microbiologia , Idoso , Animais , Antibacterianos , Brasil , DNA de Protozoário/análise , Cotovelo/microbiologia , Cotovelo/patologia , Humanos , Leishmania guyanensis , Leishmaniose Mucocutânea/complicações , Leishmaniose Mucocutânea/cirurgia , Masculino , Reação em Cadeia da Polimerase , Sporothrix , Esporotricose/complicações , Esporotricose/tratamento farmacológico , Esporotricose/patologia , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/patologia , Lesões no CotoveloRESUMO
PURPOSE: This study describes lacrimal tract involvement and surgical outcome in patients with mucocutaneous leishmaniasis. METHODS: Four patients, ages 20 to 75 years, had nasal lesions resulting from mucocutaneous leishmaniasis and sought treatment for chronic dacryocystitis. Each patient had had lacrimal symptoms since childhood or early adulthood, concomitantly with the development of upper airway lesions. Dacryocystography showed nasolacrimal duct stenosis in all cases on the affected side. Three patients underwent dacryocystorhinostomy (one bilaterally), and one patient had bilateral dacryocystectomy. RESULTS: Two patients had surgical fistula closure soon after surgery. A sequential endoscopic operation for remotion of a synechia between the fistula and the middle turbinate was successful in one of these patients. Histopathologic analysis of lacrimal sacs and nasal mucous membranes close to the anastomotic site revealed chronic nonspecific inflammatory process and negative immunohistochemistry for Leishmania. CONCLUSIONS: Dacryocystitis may result from nasal mucocutaneous leishmaniasis. The surgical outcome was unsatisfactory in one of the four patients.
Assuntos
Dacriocistite/etiologia , Leishmaniose Mucocutânea/complicações , Adulto , Idoso , Brasil/epidemiologia , Doença Crônica , Dacriocistite/diagnóstico por imagem , Dacriocistite/epidemiologia , Dacriocistite/cirurgia , Dacriocistorinostomia/métodos , Feminino , Humanos , Incidência , Leishmaniose Mucocutânea/diagnóstico por imagem , Leishmaniose Mucocutânea/epidemiologia , Leishmaniose Mucocutânea/cirurgia , Masculino , Pessoa de Meia-Idade , Ducto Nasolacrimal/diagnóstico por imagem , Ducto Nasolacrimal/cirurgia , Radiografia , Estudos RetrospectivosAssuntos
Leishmaniose Mucocutânea/cirurgia , Hanseníase/cirurgia , Doenças Nasais/cirurgia , Periósteo/cirurgia , Adulto , Feminino , Humanos , Masculino , MétodosRESUMO
The authgor presents the repair of the nasal lining in leprosy in cases of nose tip collapse through loss of chondro mucous substance. Two methods are used frontal flap and nasolabial flaps. Both methods are considered by the author to give excellent results. he mentions gillies method freeskin garft and prosthesis and finds that besides the complexity of its execution the late results are precarious.