Borderline tuberculoid leprosy associated with primary cutaneous histoplasmosis

Hanseníase dimorfa tuberculoide associada à histoplasmose cutânea primária

IMAGING IN TROPICAL DERMATOLOGY

Borderline tuberculoid leprosy associated with primary cutaneous histoplasmosis^*

Hanseníase dimorfa tuberculoide associada à histoplasmose cutânea primária

Carolina Ribas do Nascimento^I; Ronita Rocelina Carvalhal Silva Soares^II; Antônio Carlos Ceribelli Martelli^III; Maria Izilda Andrade^IV; Milton Cury Filho^V

^IDermatologist, studying for Master's Degree in Clinical Medicine/Dermatology at the Federal University of Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil

^IIDermatologist in private practice, Cruzeiro (SP), Brazil

^IIIAssistant Preceptor of Dermatology at the Lauro de Souza Lima Institute (ILSL), Bauru (SP), Brazil

^IVBiology Assistant in the Medical Mycology Department, Lauro de Souza Lima Institute (ILSL), Bauru (SP), Brazil

^VOrthopedic Surgeon at the Lauro de Souza Lima Institute (ILSL), Bauru (SP), Brazil

^{Mailing address}

ABSTRACT

We describe a case of borderline tuberculoid leprosy associated with primary cutaneous histoplasmosis in a patient who presented at our hospital with skin lesions and joint complaints.

Keywords: Granuloma; Histoplasmosis; Leprosy

RESUMO

Descrevemos um caso de hanseníase dimorfa tuberculoide associada à histoplasmose cutânea primária em um paciente que procurou nosso hospital com lesões dermatológicas e queixas articulares.

Palavras-chave: Granuloma; Hanseníase; Histoplasmose

This case concerns a 65-year-old male patient who suffered pain and lack of mobility in his right wrist a year ago and reported the appearance of erythematous plaques on his body three weeks before presenting at hospital. Examination revealed ulcers on the fingers of his right hand and an erythematousedematous plaque on the dorsum of the right hand, left shoulder and neck (Figures 1 and 2). Biopsy was performed on the dorsum of the hand and neck which showed reactional borderline tuberculoid leprosy (Figure 3). Polychemotherapy and prednisone were started on the assumption that it was "reactional hand." After treatment the joint pains noted at first consultation persisted. We decided to perform a synovial biopsy of the right wrist, with negative culture for bacteria and mycobacteria and positive for Histoplasma capsulatum (Figure 4). After diagnosing histoplasmosis, treatment commenced with itraconazole 200mg daily.

Leprosy, caused by Mycobacterium leprae, presents a wide spectrum of clinical forms, with stable, opposite poles and unstable manifestations of the disease shifting towards either pole, possibly acquiring the clinical and immunological characteristics of each of the poles. ^{1, 2}

Histoplasmosis, on the other hand, is caused by the dimorphic fungus Histoplasma capsulatum found in soil contaminated by the feces of birds and bats. ^3-6 The disease is endemic in tropical and temperate climates, especially in the Americas. ⁷

The case reported shows an association between two granulomatous diseases that has not been reported hitherto in the literature. Assuming that this case was one of reactional borderline leprosy it was to be logically expected that the lesion in the patient's hand would represent one of the symptoms generally found in such leprosy cases.

Received on 29.09.2010.

Approved by the Advisory Board and accepted for publication on 08.11.2010.

Conflict of interest: None

Financial funding: None

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*

Study performed at the Lauro de Souza Lima Institute (ILSL), Bauru (SP), Brazil.

Publication Dates

• Publication in this collection
  02 Apr 2012
• Date of issue
  Feb 2012

History

• Received
  29 Sept 2010
• Accepted
  08 Nov 2010