1/160. Anaesthetic considerations in a patient with lepromatous leprosy. PURPOSE: To consider the anaesthetic problems in a patient with lepromatous leprosy undergoing general anaesthesia. CLINICAL FEATURES: A 52 yr old man with lepromatous leprosy for five years was booked for elective radical nephrectomy. He received 100 mg dapsone per day po. The patient was asymptomatic for cardiovascular disease but his electrocardiogram showed complete left bundle branch block, inferior wall ischaemia with echocardiogram findings of 58% ejection fraction and left ventricular diastolic dysfunction. Other preoperative investigations (haemogram, serum urea and creatinine, liver function tests and chest X-ray) were normal. After premedication with diazepam, meperidine and promethazine, the patient received glycopyrrolate and anaesthesia was induced with thiopentone. atracurium was given to facilitate tracheal intubation. Anaesthesia was maintained with intermittent positive pressure ventilation using N2O in oxygen with halothane. Anaesthesia and surgery were uneventful except that the patient had a fixed heart rate that remained unchanged in response to administration of anticholinergic, laryngoscopy, intubation and extubation. CONCLUSION: patients with lepromatous leprosy may have cardiovascular dysautonomia even when they are asymptomatic for cardiovascular disease. ( info) |
2/160. A clinical and histopathological study of macular type of post-kala-azar dermal leishmaniasis. Post-kala-azar dermal leishmaniasis (PKDL) is an uncommon sequel seen in patients with a previous attack of kala-azar (KA). It is characterized by hypopigmented macules and erythematous eruptions leading to the formation of papules, plaques and nodules. Little attention has been paid to the rare group of patients who present with only hypopigmented macules. The present study has described the distribution of lesions in macular PKDL and their histopathology. ( info) |
3/160. Lepromatous lymphadenopathy and concomitant tuberculous axillary lymphadenitis with sinus. A case report. A 25-year-old male patient with florid lepromatous leprosy presented with right axillary lymphadenopathy and a discharging sinus. He also had scabies with chronic right otitis media. Histopathological examination of the lymph node revealed lepromatous lymphadenitis coexisting with tuberculosis. This unusual combination of two different clinical entities is recorded in this case report. ( info) |
4/160. A case of reconstruction of saddle nose deformity in leprosy. A case of reconstructive surgery for saddle nose deformity is presented in this paper. A 22 year-old Bengali female who had completed WHO/MB regimen for 27 months underwent reconstructive surgery for saddle nose deformity. Since a saddle nose is one of the symbols of leprosy, it often causes serious psychological and social troubles to patients. This happens more often when the patient is a young unmarried woman. In this case the saddle nose seemed to be very serious. After being discharged from hospital she got married and had a baby. This operation gave the patient great relief to live in the community, because she no longer had serious visible evidence of leprosy on the body. Though the correction of the deformity without any dysfunction does not always have priority over other surgeries at a busy leprosy control project in bangladesh, it has merit both in patients themselves and in the society around them because it leads to the elimination of the stigma of leprosy. ( info) |
5/160. Delay in diagnosis: indeterminate leprosy presenting with rheumatic manifestations. BACKGROUND: Rheumatic complications are common in leprosy (Hansen's disease) and can be the primary complaint delaying accurate diagnosis. OBJECTIVE: Such a case is reported here: a 61-year-old woman with indeterminate leprosy presented with symmetric arthritis and purpura. Despite biopsy and evaluation by several physicians, leprosy was not suspected. After 2 years of progressive symptoms, a second biopsy revealed lepromatous leprosy. CONCLUSION: In this case, lack of clinical suspicion and unfamiliarity with the histology of indeterminate leprosy delayed diagnosis and treatment. leprosy should be considered in the differential diagnosis of patients presenting with unusual rheumatic and persistent cutaneous manifestations. ( info) |
6/160. Vasculitic neuropathy in a patient with inactive treated lepromatous leprosy. A 46 year old Asian male with previously treated lepromatous leprosy developed a stepwise multifocal sensory disturbance 25 years later. neurophysiology demonstrated marked deterioration from previous studies. sural nerve biopsy disclosed a vasculitic process superimposed on inactive lepromatous leprosy. Immunocytochemical stains for mycobacterial antigen showed deposits within nerve and vessel walls. A delayed vasculitic neuropathy precipitated by persisting mycobacterial antigen is proposed. ( info) |
7/160. Epithelioid granuloma in the iris of a lepromatous leprosy patient; an unusual finding. This case report depicts a case of histopathologically confirmed polar lepromatous (LL) leprosy with a bacterial index of 4 . He experienced recurrent episodes of erythema nodosum leprosum (ENL) in the first 5 years after diagnosis. skin smears became negative after 6 years of dapsone monotherapy and have remained negative since that time. At 23 years after diagnosis, the patient had developed cataracts and underwent intracapsular cataract extractions with broad-based iridectomies. In one of the iris specimens, histopathologic examination revealed a focal granuloma composed of epithelioid cells. Subsequently a lepromin skin test showed a positive Mitsuda reaction with a borderline tuberculoid histopathology. This clearly illustrates the immunological upgrading of a polar lepromatous patient, perceived first in the iris tissue. ( info) |
8/160. Sequential erythema nodosum leprosum and reversal reaction with similar lesional cytokine mRNA patterns in a borderline leprosy patient. We compare the clinical and histological data with the immunological status of a borderline leprosy patient who experienced an erythema nodosum leprosum (ENL) reaction followed by a reversal reaction (RR) after 12 weeks of anti-inflammatory treatment (pentoxifylline, PTX, 1200 mg daily). skin biopsies, serum and blood samples were collected sequentially during the reactional episodes. At the outset of RR, the patient's lymphocytes secreted interferon (IFN) -gamma and there was a positive lymphoproliferative test in response to mycobacterium leprae, which had been absent during ENL. The lepromin reaction reversed from negative (0 mm) at diagnosis, to positive (3 mm) 3 months after the development of RR. Tumour necrosis factor (TNF) -alpha levels in the serum decreased after 1 week of treatment and increased slightly thereafter. The immunohistochemical data for ENL showed a diffuse dermal and hypodermal infiltrate composed of mononuclear cells and neutrophils, while RR was characterized by an epithelioid granulomatous infiltrate with a marked presence of gammadelta T cells. reverse transcription-polymerase chain reaction showed a mixed cytokine profile characterized by the expression of TNF-alpha, IFN-gamma, interleukin (IL) -6, IL-10 and IL-12 mRNA in the skin, which persisted throughout the development of ENL and RR lesions. IL-4 mRNA, first detected after 7 days of PTX treatment, was still present during RR. The results suggest the emergence of an initial Th0-like cytokine profile in ENL, typical of a state of immunoactivation, before conditions optimal for the appearance of an antigen-specific cell-mediated immune response and gammadelta T-cell migration are created. ( info) |
9/160. Lepromatous leprosy in an hiv-positive patient in spain. We report a 35-year-old hiv-positive male affected by lepromatous leprosy which, to our knowledge, is the first case of its kind in spain. The relationship between the two conditions is discussed. ( info) |
10/160. Relapse as histoid leprosy after receiving multidrug therapy (MDT); a report of three cases. The histoid type of leprosy has been described as occurring in lepromatous leprosy patients who relapse after many years of apparently successful dapsone monotherapy. Three patients who had received the world health organization-recommended regimens of multidrug therapy (WHO/MDT) relapsed as histoid leprosy 12-15 years after completion of treatment. In one patient, through mouse foot pad studies, the bacilli were found to be sensitive to rifampin and clofazimine and resistant to dapsone. In the other two patients mouse foot pad studies were inconclusive. The patients were re-started on WHO/MDT. Two patients took regular treatment and improved, both clinically and bacteriologically. One patient was irregular in treatment, and 1 year after re-starting WHO/MDT nodules were still present although the bacterial index had fallen slightly. ( info) |