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On-line version ISSN 1806-4841
An. Bras. Dermatol. vol.87 no.1 Rio de Janeiro Jan./Feb. 2012
IMAGING IN TROPICAL DERMATOLOGY
Borderline tuberculoid leprosy associated with primary cutaneous histoplasmosis*
Hanseníase dimorfa tuberculoide associada à histoplasmose cutânea primária
Carolina Ribas do NascimentoI; Ronita Rocelina Carvalhal Silva SoaresII; Antônio Carlos Ceribelli MartelliIII; Maria Izilda AndradeIV; Milton Cury FilhoV
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
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
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.
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Carolina Ribas do Nascimento
Rodovia Comandante João Ribeiro de Barros KM 225/226
CEP: 17034-971 Bauru - SP, Brazil
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
* Study performed at the Lauro de Souza Lima Institute (ILSL), Bauru (SP), Brazil.