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Two patients with leprosy and the sudden appearance of inflammation in the skin and new sensory loss.

Franco-Paredes C, Jacob JT, Stryjewska B, Yoder L - PLoS Negl Trop Dis (2009)

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America.

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Leprosy is a chronic infection caused by Mycobacterium leprae that affects the peripheral nerves, skin, and potentially other organs –... Thalidomide is sometimes used in combination with corticosteroids for controlling severe type 2 reactions... Its therapeutic effect has been associated with transient immune stimulation of IL-2 and interferon-γ produced by activated CD4+ and CD8+ lymphocytes... Nonetheless, thalidomide has significant limitations for widespread use: it is costly, unavailable in many settings, and has significant side effects (teratogenicity, sedation, neuropathy, and thrombosis)... Management of type 2 reactions with clofazimine is indicated in patients who are not responding satisfactorily to treatment with corticosteroids or when the risk of toxicity with corticosteroids is high ; or as monotherapy when corticosteroids are contraindicated... However, the TNF-α inhibitor infliximab has been associated with the clinical development of leprosy and, upon its discontinuation, the occurrence of type 1 reactions... The effects of other TNF inhibitors are not known... Azathioprine has been successfully used in preventing recurrences... At this point, our patient was diagnosed with a type 1 reaction... Along with continuing his MDT, he received a corticosteroid regimen tapered over a 20-week period, resulting in significant improvement (Figure 5B)... If the reversal reaction becomes chronic, requiring high doses of corticosteroids for extended periods, adjunctive clofazimine, started at 100 mg three times daily and subsequently tapered over many months, may be used (Table 3)... Leprosy reactions occur among patients with borderline and lepromatous leprosy and may occur prior to the initiation of MDT, during MDT, or even years after its completion... Long-term follow-up of patients diagnosed with leprosy and who have suffered leprosy reactions is needed, even after completion of MDT.

No MeSH data available.


Multiple non-tender nodules (0.5–1.0 cm) in the right leg.
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pntd-0000425-g002: Multiple non-tender nodules (0.5–1.0 cm) in the right leg.

Mentions: A 31-year-old Brazilian male living in the United States for the previous four years presented with progressive crops of new nontender nodules on all four extremities over a 16-month period (Figures 1 and 2). He had more than ten nodules in each limb, with some reaching 0.5–1.0 cm in diameter. A 3×5-cm area of diffuse skin infiltration was present in his left thigh. He had referred numbness in the lower extremities. He had thickened bilateral ulnar nerves with mild sensory loss by monofilament testing in the ulnar nerve and peroneal nerve territories without any nerve tenderness identified. His posterior tibial nerves were also palpable. There was no muscle weakness identified by voluntary muscle testing using the 0–5 modified Medical Research Council scale. Nasal mucosa was normal. Eyelid closure was tested and there was no evidence of lagopthalmos; eyelashes were normal. His conjunctivae were pink. A skin biopsy demonstrated a diffuse lymphocytic infiltrate with multiple foamy macrophages. Fite-Faraco staining showed multiple acid-fast bacilli (Figure 3). A skin smear demonstrated a bacterial index (BI) of 5. The patient was diagnosed with lepromatous leprosy, using the Ridley-Joplin staging system [1], or multibacillary leprosy per the World Health Organization (WHO) staging [2]–[5] (Table 1). He was started on MDT consisting of dapsone 100 mg PO daily, rifampin 600 mg PO daily, and clofazimine 50 mg PO daily. (In the United States, the National Hansen's Disease Program recommends using daily rifampin, while the rest of the world uses rifampin once monthly with less than 1% relapses [4].)


Two patients with leprosy and the sudden appearance of inflammation in the skin and new sensory loss.

Franco-Paredes C, Jacob JT, Stryjewska B, Yoder L - PLoS Negl Trop Dis (2009)

Multiple non-tender nodules (0.5–1.0 cm) in the right leg.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2742893&req=5

pntd-0000425-g002: Multiple non-tender nodules (0.5–1.0 cm) in the right leg.
Mentions: A 31-year-old Brazilian male living in the United States for the previous four years presented with progressive crops of new nontender nodules on all four extremities over a 16-month period (Figures 1 and 2). He had more than ten nodules in each limb, with some reaching 0.5–1.0 cm in diameter. A 3×5-cm area of diffuse skin infiltration was present in his left thigh. He had referred numbness in the lower extremities. He had thickened bilateral ulnar nerves with mild sensory loss by monofilament testing in the ulnar nerve and peroneal nerve territories without any nerve tenderness identified. His posterior tibial nerves were also palpable. There was no muscle weakness identified by voluntary muscle testing using the 0–5 modified Medical Research Council scale. Nasal mucosa was normal. Eyelid closure was tested and there was no evidence of lagopthalmos; eyelashes were normal. His conjunctivae were pink. A skin biopsy demonstrated a diffuse lymphocytic infiltrate with multiple foamy macrophages. Fite-Faraco staining showed multiple acid-fast bacilli (Figure 3). A skin smear demonstrated a bacterial index (BI) of 5. The patient was diagnosed with lepromatous leprosy, using the Ridley-Joplin staging system [1], or multibacillary leprosy per the World Health Organization (WHO) staging [2]–[5] (Table 1). He was started on MDT consisting of dapsone 100 mg PO daily, rifampin 600 mg PO daily, and clofazimine 50 mg PO daily. (In the United States, the National Hansen's Disease Program recommends using daily rifampin, while the rest of the world uses rifampin once monthly with less than 1% relapses [4].)

View Article: PubMed Central - PubMed

Affiliation: Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, United States of America.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Leprosy is a chronic infection caused by Mycobacterium leprae that affects the peripheral nerves, skin, and potentially other organs –... Thalidomide is sometimes used in combination with corticosteroids for controlling severe type 2 reactions... Its therapeutic effect has been associated with transient immune stimulation of IL-2 and interferon-γ produced by activated CD4+ and CD8+ lymphocytes... Nonetheless, thalidomide has significant limitations for widespread use: it is costly, unavailable in many settings, and has significant side effects (teratogenicity, sedation, neuropathy, and thrombosis)... Management of type 2 reactions with clofazimine is indicated in patients who are not responding satisfactorily to treatment with corticosteroids or when the risk of toxicity with corticosteroids is high ; or as monotherapy when corticosteroids are contraindicated... However, the TNF-α inhibitor infliximab has been associated with the clinical development of leprosy and, upon its discontinuation, the occurrence of type 1 reactions... The effects of other TNF inhibitors are not known... Azathioprine has been successfully used in preventing recurrences... At this point, our patient was diagnosed with a type 1 reaction... Along with continuing his MDT, he received a corticosteroid regimen tapered over a 20-week period, resulting in significant improvement (Figure 5B)... If the reversal reaction becomes chronic, requiring high doses of corticosteroids for extended periods, adjunctive clofazimine, started at 100 mg three times daily and subsequently tapered over many months, may be used (Table 3)... Leprosy reactions occur among patients with borderline and lepromatous leprosy and may occur prior to the initiation of MDT, during MDT, or even years after its completion... Long-term follow-up of patients diagnosed with leprosy and who have suffered leprosy reactions is needed, even after completion of MDT.

No MeSH data available.