Borderline lepromatous leprosy

Abstracts

É apresentado caso de hanseníase borderline virchowiana com quatro anos de evolução e lesões cutâneas de difícil diagnóstico na rede de saúde. O exame histopatológico mostrando estruturas granulomatosas desorganizadas e múltiplos bacilos álcool-ácido resistentes foi essencial para o diagnóstico. Casos como o descrito possibilitam a contaminação dos conviventes e o surgimento de novos casos de hanseníase no futuro.

Hanseníase; Hanseníase dimorfa; Hanseníase Virchowiana

IMAGES IN TROPICAL DERMATOLOGY

^ISpecialist in Dermatology by the Brazilian Society of Dermatology - Dermatologist of the Tropical Medicine Foundation of Amazonas - Manaus(AM),Brazil

^IIDoctorate - Dermatology professor of the State University of Amazonas - Manaus(AM),Brazil

^IIIMD- Dermatology resident of the Tropical Medicine Foundation of Amazonas Manaus(AM),Brazil

^IVMD- Dermatology resident of the Tropical Medicine Foundation of Amazonas Manaus(AM),Brazil

^VDoctorate in Tropical Medicine - Dermatologist of the Tropical Medicine Foundation of Amazonas - Manaus(AM),Brazil

^VIDoctorate in Dermatology - Director of the Tropical Medicine Foundation of Amazonas - Manaus (AM), Brazil

Mailing address

ABSTRACT

It is presented a case of borderline lepromatous leprosy with 4 years of evolution and cutaneous lesions of difficult diagnosis in the National Health System. The histopathological evaluation, which was essential for the diagnosis, showed disorganized granulomatous structures and multiple alcohol -acid resistant bacilli. Cases like the one described here are responsible for the contamination of cohabitants and the appearance of new cases of leprosy.

Keywords: Leprosy; Leprosy, bordeline Leprosy, lepromatous

Borderline lepromatous leprosy manifests itself by a large number of lesions, with various aspects such as: infiltrations, plaques (some with the central region apparently spared), outer edges badly defined and nodules. ^1-3 Lesions are not so symmetrical as for lepromatous and there is tickening of a great number of nerve trunks.¹ Smear is positive, with inumerous bacilli. ^1-3 The clinical classification of borderline patients is, many times, as in the case presented here, (Figures 1 and 2) difficult. Cutaneous manifestations may not fit into the clinical patterns described or the histopathological exam is not compatible with the clinical classification.^4,5 In these cases, the MHB classification is simply adopted and the patient is treated according to smear result (Figures 3 e 4) or according to the classification of the World Health Organization in accordance with the number of lesions¹. Undiagnosed patients with active tuberculosis evolving for years, as the case reported here, enable the contamination of cohabitants and the emergence of new cases of Hansen's disease in the future.¹

REFERENCES

• 1. Talhari S, Neves RG, de Oliveira MLW, de Andrade ARC, Ramos AMC, Penna GO, Talhari AC. Manifestações cutâneas e diagnóstico diferencial. In: Talhari S, Neves RG, Penna GO, de Oliveira MLV, editores. Hanseníase. 4 ed. Manaus: Editora Lorena; 2006. p. 21-58.
• 2. Foss NT. Hanseníase: aspectos clínicos, imunológicos e terapêuticos. An Bras Dermatol. 1999;74:113-9.
• 3. Walker SL, Lockwood DN. Leprosy. Clin Dermatol. 2007;25:165-72.
• 4. Ridley DS, Jopling WH. A classification of leprosy for research purposes. Lepr Rev. 1962;33:119-28.
• 5. Ridley DS, Jopling WH. Classification of leprosy according to immunity. A five-group system. Int J Lepr Other Mycobact Dis. 1966;34:255-73.

Borderline lepromatous leprosy

Christiane Matsuo^I; Carolina Talhari^II; Lisiane Nogueira^III; Renata Fernandes Rabelo^IV; Mônica Nunes dos Santos^V; Sinesio Talhari^VI

Publication Dates

• Publication in this collection
  27 Jan 2011
• Date of issue
  Dec 2010

History

• Received
  16 July 2010