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Lepromatous leprosy and perianal tuberculosis: a case report and literature review.

Parise-Fortes MR, Lastória JC, Marques SA, Putinatti MS, Stolf HO, Marques ME, Haddad V - J Venom Anim Toxins Incl Trop Dis (2014)

Bottom Line: Tuberculosis is predominantly a disease of the lungs; however, it may spread to other organs and cause an extrapulmonary infection.Both mycobacterial infections are endemic in developing countries including Brazil, and cases of coinfection have been reported in the last decade.Nevertheless, simultaneous occurrence of perianal cutaneous tuberculosis and erythema nodosum leprosum is very rare, even in countries where both mycobacterial infections are endemic.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Dermatology, Botucatu Medical School, São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu São Paulo State, Brasil ; Departamento de Dermatologia e Radioterapia, Faculdade de Medicina de Botucatu, UNESP, Distrito de Rubião Junior, Botucatu, SP CEP 18618-970, Brasil.

ABSTRACT
Leprosy is a chronic infectious disease caused by Mycobacterium leprae, a microorganism that usually affects skin and nerves. Although it is usually well-controlled by multidrug therapy (MDT), the disease may be aggravated by acute inflammatory reaction episodes that cause permanent tissue damage particularly to peripheral nerves. Tuberculosis is predominantly a disease of the lungs; however, it may spread to other organs and cause an extrapulmonary infection. Both mycobacterial infections are endemic in developing countries including Brazil, and cases of coinfection have been reported in the last decade. Nevertheless, simultaneous occurrence of perianal cutaneous tuberculosis and erythema nodosum leprosum is very rare, even in countries where both mycobacterial infections are endemic.

No MeSH data available.


Related in: MedlinePlus

Perianal ulcer completely healed with antituberculous treatment for two months.
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Figure 8: Perianal ulcer completely healed with antituberculous treatment for two months.

Mentions: Four weeks later, the patient had fever, weight loss, asthenia and worsening of the perianal ulcer (Figure 5), but without erythema nodosum leprosum. With this clinical picture, new investigation was developed. The tuberculin skin test was positive (20 × 20 mm) and culture of M. tuberculosis – using a biopsy sample from the perianal ulcer – on Löwenstein-Jensen medium was positive (Figure 6). Polymerase chain reaction (PCR) and DNA analysis from upper limb skin samples were positive for M. leprae (Figure 7). With the new information the patient was finally diagnosed as presenting simultaneously lepromatous leprosy – type 2 reaction – and cutaneous tuberculosis expressed by the perianal ulcer. Screening for HIV, HBV or HCV infection as well as lung, renal or colon compromising were negative. Hence, the patient was treated with isoniazid, ethambutol and rifampin for nine months with complete healing of the perianal and inguinal lesions after two months (Figure 8). After the tuberculosis treatment, the patient was submitted to additional multidrug therapy for 12 months with dapsone, rifampin and clofazimine with complete cure of leprosy.


Lepromatous leprosy and perianal tuberculosis: a case report and literature review.

Parise-Fortes MR, Lastória JC, Marques SA, Putinatti MS, Stolf HO, Marques ME, Haddad V - J Venom Anim Toxins Incl Trop Dis (2014)

Perianal ulcer completely healed with antituberculous treatment for two months.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4150118&req=5

Figure 8: Perianal ulcer completely healed with antituberculous treatment for two months.
Mentions: Four weeks later, the patient had fever, weight loss, asthenia and worsening of the perianal ulcer (Figure 5), but without erythema nodosum leprosum. With this clinical picture, new investigation was developed. The tuberculin skin test was positive (20 × 20 mm) and culture of M. tuberculosis – using a biopsy sample from the perianal ulcer – on Löwenstein-Jensen medium was positive (Figure 6). Polymerase chain reaction (PCR) and DNA analysis from upper limb skin samples were positive for M. leprae (Figure 7). With the new information the patient was finally diagnosed as presenting simultaneously lepromatous leprosy – type 2 reaction – and cutaneous tuberculosis expressed by the perianal ulcer. Screening for HIV, HBV or HCV infection as well as lung, renal or colon compromising were negative. Hence, the patient was treated with isoniazid, ethambutol and rifampin for nine months with complete healing of the perianal and inguinal lesions after two months (Figure 8). After the tuberculosis treatment, the patient was submitted to additional multidrug therapy for 12 months with dapsone, rifampin and clofazimine with complete cure of leprosy.

Bottom Line: Tuberculosis is predominantly a disease of the lungs; however, it may spread to other organs and cause an extrapulmonary infection.Both mycobacterial infections are endemic in developing countries including Brazil, and cases of coinfection have been reported in the last decade.Nevertheless, simultaneous occurrence of perianal cutaneous tuberculosis and erythema nodosum leprosum is very rare, even in countries where both mycobacterial infections are endemic.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Dermatology, Botucatu Medical School, São Paulo State University (UNESP - Univ Estadual Paulista), Botucatu São Paulo State, Brasil ; Departamento de Dermatologia e Radioterapia, Faculdade de Medicina de Botucatu, UNESP, Distrito de Rubião Junior, Botucatu, SP CEP 18618-970, Brasil.

ABSTRACT
Leprosy is a chronic infectious disease caused by Mycobacterium leprae, a microorganism that usually affects skin and nerves. Although it is usually well-controlled by multidrug therapy (MDT), the disease may be aggravated by acute inflammatory reaction episodes that cause permanent tissue damage particularly to peripheral nerves. Tuberculosis is predominantly a disease of the lungs; however, it may spread to other organs and cause an extrapulmonary infection. Both mycobacterial infections are endemic in developing countries including Brazil, and cases of coinfection have been reported in the last decade. Nevertheless, simultaneous occurrence of perianal cutaneous tuberculosis and erythema nodosum leprosum is very rare, even in countries where both mycobacterial infections are endemic.

No MeSH data available.


Related in: MedlinePlus