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Print version ISSN 0365-0596
An. Bras. Dermatol. vol.85 no.6 Rio de Janeiro Nov./Dec. 2010
IMAGES IN TROPICAL DERMATOLOGY
Christiane MatsuoI; Carolina TalhariII; Lisiane NogueiraIII; Renata Fernandes RabeloIV; Mônica Nunes dos SantosV; Sinesio TalhariVI
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
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
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. [ Links ]
2. Foss NT. Hanseníase: aspectos clínicos, imunológicos e terapêuticos. An Bras Dermatol. 1999;74:113-9. [ Links ]
3. Walker SL, Lockwood DN. Leprosy. Clin Dermatol. 2007;25:165-72. [ Links ]
4. Ridley DS, Jopling WH. A classification of leprosy for research purposes. Lepr Rev. 1962;33:119-28. [ Links ]
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. [ Links ]
Approved by the Editorial Board and accepted for publication on 16.07.2010. * Work carried out in the Tropical Medicine Foundation of Amazonas - Manaus (AM), Brazil.
Conflict of interest: None
Financial funding: Fundação de Medicina Tropical do Amazonas
Approved by the Editorial Board and accepted for publication on 16.07.2010.
* Work carried out in the Tropical Medicine Foundation of Amazonas - Manaus (AM), Brazil.