1/37. Vasculitic neuropathy in a patient with inactive treated lepromatous leprosy.A 46 year old Asian male with previously treated lepromatous leprosy developed a stepwise multifocal sensory disturbance 25 years later. neurophysiology demonstrated marked deterioration from previous studies. sural nerve biopsy disclosed a vasculitic process superimposed on inactive lepromatous leprosy. Immunocytochemical stains for mycobacterial antigen showed deposits within nerve and vessel walls. A delayed vasculitic neuropathy precipitated by persisting mycobacterial antigen is proposed.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/37. Lepromatous vasculitis successfully treated by plasma exchange (PE).Vascular involvement is presently considered a "common pathway" in a number of diseases that is mediated by circulating immune complexes (CIC). CIC are found in the circulation when the disease is active and in single patients their level may parallel disease activity. Lepromatous leprosis is characterized by the presence of CIC and deposits of immunoglobulins and complement in vascular lesions of the different organs and an Arthus-like mechanism is considered as the basis for the clinical picture. The same mechanism is considered to play an essential pathophysiologic role in Lucio's phenomenon, which is characterized by lymphohistiocytic vascular infiltrates with or without thrombosis and secondary cutaneous infarction. Lepromatous vascular involvement is mediated by CIC whose antigen composition is known, the same as it is with HCV mediated cryoglobulinemia, HBV positive panarteritis nodosa, rheumatoid vasculitis, or Wagner's granulomatosis, which are usually treated by PE [1-3]. PE has been employed for lepromatous vasculitis since 1979 [4] and other cases have been successfully treated afterwards [5,6]. We report on another patient successfully treated by plasma exchange.- - - - - - - - - - ranking = 0.0065160023786791keywords = organ (Clic here for more details about this article) |
3/37. nocardia farcinica pleuritis in a lepromatous patient with severe necrotizing reaction: an unusual presentation.A young, male, lepromatous leprosy patient with a severe necrotizing erythema nodosum leprosum reaction treated with prolonged oral steroids and thalidomide developed pleuritis that was caused by a rare opportunistic pathogen, nocardia farcinica. This organism was resistant to most antibiotics but was susceptible to amikacin and minocycline. During the course of treatment the patient developed severe gastritis which necessitated the removal of clofazimine and the inclusion of an H2 receptor antagonist. Bilateral steroid-induced cataracts needed surgical correction. This case is being presented for its rare opportunistic bacterial infection and for the multiple complications which made treatment difficult.- - - - - - - - - - ranking = 0.0065160023786791keywords = organ (Clic here for more details about this article) |
4/37. Asymptomatic nerve hypertrophy in lepromatous leprosy: a clinical, electrophysiological and morphological study.In order to learn more about early nerve lesions observed in leprosy, we performed a clinical, electrophysiological and morphological study in seven patients with untreated lepromatous leprosy, palpably enlarged radial cutaneous nerve and preserved sensation in the corresponding territory. The conduction velocity of the cutaneous radial nerve, which was decreased in all patients, did not significantly differ from that of a group of patients with lepromatous leprosy, hypertrophy of the radial cutaneous nerve and sensory loss. In contrast, the sensory action potential was significantly lower in patients with sensory loss, which demonstrates that axon loss is more important than demyelination in producing sensory loss. In all patients nerve enlargement was due to thickening of the epineurium and of the perineurium subsequent to inflammatory infiltrates and proliferation of fibroblasts and perineurial cells. In several fascicles, the inflammatory infiltrates and the infected cells infiltrated endoneurial connective tissue septa and blood vessels. Mycobacteria leprae were abundant in perineurial cells, fibroblasts, macrophages, schwann cells and endothelial cells, and lymphocytic vasculitis present in all cases. The average density of myelinated fibres was 2600 SD 880 fibres/mm2 (control: 7700 fibres/mm2), with marked differences between individual fascicles, versus 420 fibres/mm2 in patients with nerve hypertrophy and sensory loss (range 0-2080 fibres/mm2). Single fibre preparations showed that segmental demyelination predominated in two patients, axonal degeneration in one, while inflammatory infiltrates and proliferation of connective tissue adhering to individual fibres were prominent in the others.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 5keywords = nerve (Clic here for more details about this article) |
5/37. Lepromatous leprosy in a heart transplant recipient.Northern louisiana is not an area for indigenous cases of leprosy. Limited data are available on the occurrence of leprosy in organ transplant recipients. No cases have been reported in heart transplant recipients. Mr J.R. is a 68-year-old man from Shreveport, louisiana. He underwent orthotopic heart transplantation in March 1996. He presented in March 2000 with a maculopapular skin rash and intermittent hand swelling for 5 months. He also complained of intermittent burning of his feet for a year. The skin lesions were of two types - a fine red migratory, intermittent maculopapular rash over the upper torso and a raised, larger, violaceaous lesion on his hands. Neurological examination revealed complete loss of protective sensation in the right foot by filamentous test and some loss in the left foot. Punch skin biopsies from his right arm and right chest lesion revealed abundant acid-fast bacilli (AFB). Histopathologic examination revealed perivascular, interstitial and perineural granulomatous inflammation and a large number of AFB organisms within histiocytes. culture of the skin biopsy specimen was negative for mycobacterium tuberculosis or atypical mycobacterium. polymerase chain reaction (PCR) performed for mycobacterium leprae was positive. The patient was treated with a modified regimen consisting of dapsone 100 mg qd, ethionamide 250 mg qd, and minocycline 100 mg qd. His skin rash and neurological symptoms have resolved.- - - - - - - - - - ranking = 0.013032004757358keywords = organ (Clic here for more details about this article) |
6/37. Lepromatous leprosy and reversal reaction in a Micronesian immigrant.A 25-year-old Micronesian man from the island of Otia developed erythematous plaques on his legs. He was diagnosed with erythema nodosum and treated with systemic prednisone. Two months later, he presented with erythematous nodules on his forehead, cheeks, and chin (Fig. 1). Examination revealed scattered violaceous papules on his chest, arms, forearms, hands, and feet, and deep purple macules on his palms and soles. Laboratory evaluation included negative serologies for human immunodeficiency virus, rapid plasma reagin, and hepatitis a, B, and C. Routine histopathology revealed nodular aggregates of histiocytes, plasma cells, and lymphocytes. histiocytes showed basophilic clusters of organisms within vacuoles, suggesting globi. Acid-fast stain revealed numerous acid-fast-positive rod-shaped organisms. The bacterial index on the Fite stain was four (bacterial index/Ridley's logarithmic scale, indicating 10-100 bacteria/high power field) (Fig. 2). An acid-fast stain obtained from a smear of tissue was positive for acid-fast bacilli, but no acid-fast bacilli were cultured. After the first day of treatment with dapsone 100 mg, rifampin 600 mg, and clofazimine 50 mg, the patient complained of burning and pain in his ankles and wrists. There was intense erythema within the lesions. edema developed in his hands and feet. Consultation with the Gillis W. Long Hansen's disease Center in Carville, louisiana, recommended prompt treatment with corticosteroids. The edema of the hands and wrists was treated as a type I reversal reaction with prednisone 1 mg/kg/day. Subsequently, the edema and neuralgia quickly resolved in his distal extremities.- - - - - - - - - - ranking = 0.013032004757358keywords = organ (Clic here for more details about this article) |
7/37. molluscum contagiosum-like lesions in lepromatous leprosy.A 23-year old male presented with multiple, asymptomatic, raised lesions of 4 months' duration. The lesions were well demarcated. Dome-shaped papules and nodules were seen on normal looking skin; some were shiny, pearly white and umbilicated. Bilateral greater auricular, ulnar, radial cutaneous and lateral popliteal nerves were thickened. Slit skin smear from an umbilicated nodule had a BI of 6 . biopsy showed features of lepromatous leprosy.- - - - - - - - - - ranking = 0.5keywords = nerve (Clic here for more details about this article) |
8/37. Bullous erythema nodosum leprosum: a case report from nepal.A patient with lepromatous leprosy, while on WHO multidrug therapy (MDT) for multibacillary disease, was diagnosed as having dapsone syndrome with recurrent episodes of bullous lesions on the lower extremities for 4-5 years. The lesions were associated with high-grade fever. Examination revealed multiple hypopigmented macules on the limbs. Multiple atrophic scars were also found on the buttocks and lower limbs. Bilateral ulnar, radial cutaneous and lateral popliteal nerves were thickened. On day 10 of WHO-MB-MDT he developed a flaccid bulla on the lower leg. skin slit smear showed a bacterial index (BI) of 3 and the histopathology was consistent with type II reaction. High dose corticosteroid therapy was started but he continued to have new lesions, and was therefore referred to a centre where thalidomide was available. Clinical response was good and he remained symptom-free after gradual reduction in dosage. ENL should be differentiated from bullous drug reactions, pemphigus vulgaris, bullous pemphigoid and other blistering diseases.- - - - - - - - - - ranking = 0.5keywords = nerve (Clic here for more details about this article) |
9/37. Involvement of genitofemoral nerve with genital lesions in lepromatous leprosy.The case of a male patient diagnosed to have lepromatous leprosy with type 2 reaction on multibacillary multidrug therapy, with unusual, widespread involvement of genitalia in the form of plaque and nodules of leprosy over scrotum and perimeatal region of glans, necrotic lesions of erythema nodosum leprosum over scrotum, neuritis of genital branch of genitofemoral nerve bilaterally, and azoospermia, is reported.- - - - - - - - - - ranking = 2.5keywords = nerve (Clic here for more details about this article) |
10/37. Lepromatous iridocyclitis.A 36-year-old woman with no prior medical history presented with a unilateral decrease in vision and iridocyclitis to our hospital. External examination demonstrated multifocal, firm, elevated, non-tender skin nodules on the patient's face and left hand. In addition, slit-lamp biomicroscopy revealed gray, cheesy-appearing nodules on the iris surface of the affected eye. anterior chamber paracentesis and pars plana vitrectomy did not reveal further information. skin nodule biopsy, however, demonstrated multiple fragmented organisms within histiocytes, consistent with leprosy. The iridocyclitis resolved after treatment with dapsone, corticosteroids, and rifampin and her vision returned to 20/20.- - - - - - - - - - ranking = 0.0065160023786791keywords = organ (Clic here for more details about this article) |
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