| A light and electron microscope study was made of resin embedded facial nerves in three cases of leprosy involving the facial nerve. The patients had irreversible facial nerve palsies and had requested facial reconstruction. No consistent pattern of nerve fibre damage was found. In one case the temporozygomatic was affected, but the cervical branch was normal, suggesting the damage begins distally. In two cases the loss of nerve fibres in the trunk and all branches was similar, and is likely to emanate from damage at a more proximal site. The presence of increased numbers of unmyelinated axons, often in clusters, is evidence of regeneration. These axons probably have the potential to develop into functional myelinated fibres provided that they can innervate a viable distal target such as a muscle graft. These regenerating axons are distal to the stylomastoid foramen suggesting that the most proximal level of involvement of the facial nerve could be intracranial. The finding of a more proximal level of nerve involvement, implies that the mis-reinnervation seen in partially recovered facial nerve palsies in leprosy, could be due to some regenerating axons being mis-directed at the level of the main trunk bifurcation. ( info) |
2/65. A recurrent case of BT leprosy with widely spread skin lesions showing a histopathology of indeterminate group after 4.5-years irregular treatment, bangladesh. A 29 year-old Bengali male case is presented in this paper which was a borderline tuberculoid leprosy (BT) at detection. His father contracted a lepromatous leprosy of G = 2 deformity. He took anti-leprosy drugs including MDT/MB regimen irregularly and had maculae widely-spread with anesthesia 16 months after being released from treatment (RFT). The histopathology of the maculae unexpectedly showed that of an indeterminate group of leprosy. The recurrent skin lesions were susceptive to a four-week regimen of Rifampicin and ofloxacin. This case can not be defined as a relapsed case, because slit skin smears were always negative. It would be called a recurrent case after MDT/MB regimen. Though the reason recurrent skin lesions occur is unknown, it is reasonable to assume that the recurrent lesions are caused by dormant persisters which are originally drug sensitive. The recurrent skin lesions can not be classified because the clinical features can not be matched to their histology. Such recurrent cases might occur among the defaulters of MDT in future. ( info) |
3/65. Generalized annular borderline tuberculoid leprosy and update in management of Hansen's disease. We describe a patient with widespread borderline tuberculoid leprosy and significant peripheral nerve involvement. Despite the presence of widespread lesions, Fite stains and polymerase chain reaction studies were initially negative. We discuss the diagnosis and treatment of leprosy including recent changes in treatment regimens and duration. ( info) |
4/65. Three cases of pure neuritic (PN) leprosy at detection in which skin lesions became visible during their course. Pure neuritic leprosy (PN leprosy) is a type of leprosy with nerve involvement, but without obvious skin lesions. It is not uncommon in the south of bangladesh, but its nature is less recognized than that in other types of leprosy. male is dominant on its occurrence with higher disability grading. The histopathological study shows that the entire spectrum can be observed in nerves of PN leprosy. There was no relation among clinical parameters, such as the number and distribution of affected nerves, the immune response and its histopathology. Therefore the treatment of PN leprosy is not well-established at field level. Out of 1,741 newly detected cases by Dhanjuri leprosy Project--Khulna Branch (PIME Sisters) in Khulna, the south of bangladesh from 1994 to 1998, 141, or 8.10% were diagnosed as PN leprosy. 6 cases out of 1,741, or 0.34% were canceled afterwards because of wrong diagnosis, of which one misdiagnosed as PN leprosy. Three cases out of 140 of primary neuritic leprosy proved to have obvious skin lesions some time after their treatment started. The details of the three cases are described in this paper. ( info) |
5/65. Serious side effects of rifampin on the course of WHO/MDT: a case report. A male born in 1935 was diagnosed as having lepromatous leprosy when he was 17 years old. In addition to dapsone (DDS) monotherapy, he had been treated with rifampin (RMP) for 2 terms: first with 450 mg a day for 2 years when he was 39 years old; second with 150 mg a day for 2 months after a 1-year interval from the first regimen. During these entire courses with RMP, no complication was noted. When he was 64 years old in 1999, a diagnosis of relapsed borderline tuberculoid (BT) leprosy was made, and he was started on the multibacillary (MB) regimen of the world health organization multidrug therapy (WHO/MDT). After the third dose of monthly RMP, he developed a flu-like syndrome and went into shock. A few hours later, intravascular hemolysis occurred followed by acute renal failure. He was placed on hemodialysis for 7 series and recovered almost completely about 2 months later. The immune complexes with anti-RMP antibody followed by complement binding may have accounted for these symptoms. Twenty-four reported cases of leprosy who had developed side effects of RMP under an intermittent regimen were analyzed; 9 of the cases had had prior treatment with RMP but 15 had not. Adverse effects were more likely to occur in MB cases and were more frequent during the first 6 doses of intermittent regimens. The cases with prior treatment with RMP had had a higher incidence of serious complications such as marked hypotension, hemolysis and acute renal failure. However, many exceptions were also found, and we could not verify any fully dependable factor(s) to predict the side effects of RMP. More field investigation is desirable, and monthly administration of RMP must be conducted under direct observation through the course of WHO/MDT. ( info) |
6/65. Hansen's disease in a patient with a history of sarcoidosis. We report a rare case of concomitant Hansen's disease (HD) and sarcoidosis. reticulin staining may be a helpful diagnostic tool in establishing the diagnosis of sarcoidosis in skin lesions. The diagnosis of HD can be established despite negative polymerase chain reaction results for the detection of mycobacterium leprae dna. Finally, a well-established diagnosis of sarcoidosis does not preclude the development of another granulomatous disorder. Hence, when new lesions developed in a patient with sarcoidosis despite appropriate therapy, other concurrent diagnoses should be pursued. ( info) |
7/65. Cutaneous granulomas masquerading as tuberculoid leprosy in a patient with congenital combined immunodeficiency. Combined immunodeficiency disorders are characterized by abnormalities in cellular and humoral immunity. This classification includes common variable immunodeficiency (CVI), a primary immunodeficiency disorder characterized by hypogammaglobulinemia, recurrent bacterial infections, and significant T-cell abnormalities. Associated autoimmune diseases include rheumatoid arthritis, pernicious anemia, idiopathic thrombocytopenic purpura, and systemic lupus erythematous. Granulomatous lesions in lymphoid tissues, solid organs, and skin have been reported. We describe a patient with CVI who developed cutaneous granulomas with perineural invasion; to our knowledge, this is a previously undescribed feature. ( info) |
8/65. Borderline tuberculoid leprosy of the scalp. A case of borderline tuberculoid leprosy involving the hairy scalp is reported. To the best of our knowledge, only two paucibacillary leprosy patients with scalp lesion have been reported, and in only one was the scalp covered with hair. ( info) |
9/65. Borderline tuberculoid leprosy: an immune reconstitution phenomenon in a human immunodeficiency virus-infected person. Two months after starting highly active antiretroviral treatment (HAART), an individual with human immunodeficiency virus type 1 (hiv-1) infection and profound CD4 T lymphocytopenia developed several erythematous plaques on his face, which were due to borderline tuberculoid leprosy with reversal reaction. The temporal association between the development of these lesions and changes in blood CD4 lymphocyte count and plasma hiv-1 load observed during HAART strongly suggests that the presentation of leprosy resulted from immune reconstitution. ( info) |
10/65. Location of the extracranial extent of leprous facial nerve pathology may allow leprous facial palsy to be reanimated by free muscle transfer. leprosy is a mycobacterial nerve and skin infection, which can be eradicated by antibiotics. Some patients affected by leprosy, once cured, have residual nerve impairment with paralysis and sensory neuropathy. A series of patients with facial nerve paralysis, investigated using clinical, histological and electrophysiological techniques, demonstrated that the nerve pathology was distal to the section of main trunk prior to its bifurcation. Facial reanimation was achieved with a free gracilis-muscle transfer, coapting its motor nerve to the ipsilateral facial nerve trunk proximal to the site of the leprosy pathology, with a moderate clinical result. ( info) |