Persistent Leprosy Reaction 8 Years After the End of Therapy: Challenges for Doctors and Patients
Abstract
Introduction: In addition to infection with Mycobacterium leprae, type 1 and 2 reactions represent acute inflammatory events in the chronic course of multibacillary leprosy, which may persist for long periods.
Case Report: A young woman presenting borderline lepromatous leprosy and persistent type 2 reaction with difficult clinical conduction.
Discussion: The case illustrates the diagnostic challenge in leprosy with a systemic inflammatory response, more expressive than the dermato – neurological features. The clinical, histopathological and therapeutic implications, as well as risk factors for reaction and also polymerase chain reaction 8 years after being discharged from treatment of multidrug therapy are discussed.
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References
Ministério da Saúde (BR), Secretaria de Vigilância em Saúde, Departamento de Vigilância das Doenças Transmissíveis. Diretrizes para vigilância, atenção e eliminação da Hanseníase como problema de saúde pública: manual técnico-operacional. Brasília: MS, SVS, DVDT; 2016.
Voorend CG, Post EB. A systematic review on the epi- demiological data of erythema nodosum leprosum, a type 2 leprosy reaction. PLoS Negl Trop Dis. 2013; 7: e2440. doi: 10.1371/journal.pntd.0002440
Putinatti MS, Lastória JC, Padovani CR. Prevention of repeated episodes of type 2 reaction of leprosy with the use of thalidomide 100 mg/day. An Bras Derma- tol. 2014; 89: 266-72.
Gupta P, Saikia UN, Arora S, De D, Radotra BD. Pan- niculitis: A dermatopathologist’s perspective and ap- proach to diagnosis. Indian J Dermatopathol Diagn Dermatol. 2016; 3: 29-41.
Guerra JG, Penna GO, Castro LC, Martelli CM, Ste- fani MM, Costa MB. Avaliação de série de casos de eritema nodoso hansênico: perfil clínico, base imuno- lógica e tratamento instituído nos serviços de saúde. Rev Soc Bras Med Trop. 2004; 37: 384-90.
Fleury RN, Ura S, Borges MB, Ghidella CC, Opro- mollas DV. Panarterites cutâneas como manifestações tardias do eritema nodoso hansênico. Hansen Inr. 1999; 24121: 103-8.
Stefani MM, Guerra JG, Sousa AL, Costa MB, Oliveira ML, Martelli CT, et al. Potential plasma markers of type 1 and type 2 leprosy reactions: a preliminary report. BMC Infect Dis. 2009;9:75. doi: 10.1186/1471- 2334-9-75.
Silva LM, Barsaglini RA. A reação é o mais difícil, é pior que hanseníase: contradições e ambiguidades na experiência de mulheres com reações hansênicas. Physis. 2018; 28: 1-19.
Pepler WJ, Kooij R, Marshall J. The histopathology of acute panniculitis nodosa leprosa (erythema nodosum leprosum). Int J Lepr. 1955;23:53-60.
Vieira AP, Trindade MA, Paula FJ, Sakai-Valente NY, Duarte AJ, Lemos FB,et al. Severe type 1 upgrading leprosy reaction in a renal transplant recipient: a pa- radoxical manifestation associated with deficiency of antigen-specific regulatory T-cells? BMC Infect Dis. 2017;17:305. doi: 10.1186/s12879-017-2406-9.
Ramos-e-Silva M, Oliveira ML, Munhoz-da-Fontoura GH. Leprosy: uncommon presentations. Clin Derma- tol. 2005; 23: 509-14.
Oliveira ML, Cavaliére FA, Maceira JM, Bührer-Sékula S. The use of serology as an additional tool to support diagnosis of difficult multibacillary leprosy cases: les- sons from clinical care. Rev Soc Bras Med Trop. 2008; 41: 27-33.
Kiran KU, Krishna KV, Meher V, Rao PN. Relapse of leprosy presenting as nodular lymph node swelling. Indian J Dermatol Venereol Leprol. 2009;75:177-9.
Marcos GC, Costa AL, Pinto YP, Pompeu VM, Moura RD, Braga AR,et al. Panniculitis by leprosy: Case re- port of a diagnostic challenge. Asian Pac J Trop Dis. 2017; 7: 625-7.
Gupta UD, Katoch K, Singh HB, Natrajan M, Katoch VM. Persister studies in leprosy patients after multi- -drug treatment. Int J Lepr Other Mycobact Dis. 2005;73:100-4.
Moura DF, de Mattos KA, Amadeu TP, Andrade PR, Sales JS, Schmitz V, et al. CD163 favors Mycobac- terium leprae survival and persistence by promoting anti-inflammatory pathways in lepromatous ma- crophages. Eur J Immunol. 2012;42:2925-36. doi: 10.1002/eji.201142198.
Negera E, Walker SL, Bobosha K, Bekele Y, Endale B, Tarekegn A, et al. The effects of prednisolone treat- ment on cytokine expression in patients with erythe- ma nodosum leprosum reactions. Front Immunol. 2018;9:189. doi: 10.3389/fimmu.2018.00189.
Goulart IMB, Goulart LR. Leprosy: diagnostic and control challenges for a worldwide disease. Arch Dermatol Res. 2008;300:269-90. doi: 10.1007/ s00403-008-0857-y.
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