Type I and type II reactions in a patient with ten years of follow-up
Autor(a) principal: | |
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Data de Publicação: | 2002 |
Outros Autores: | , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Hansenologia Internationalis (Online) |
Texto Completo: | https://periodicos.saude.sp.gov.br/hansenologia/article/view/36418 |
Resumo: | It is reported the case of a 52 year-old man who had presented signs and symptoms of multibacillary leprosy for 20 years, but sought for treatment for his disease only fiveyears after the first onset while presenting ENL with joint involvement. During the treatment (MDT-MB) the patient continued to present ENH episodes and this situation persisted even after he was released from treatment. These ENL episodes occurred alternated or concomitantly with type 1 reactional episodes (Reversal Reaction) which defined him as a borderline case. He remained like that for 10 years, presenting spleenomegaly and hypersplenism signs in one occasion. He improved only after viable bacilli were detected leading to re-administration of the MDT. The discussion of the case emphasizes some interesting aspects of the evolution of the case: 1) delayed diagnosis leading borderline patients to acquire lepromatous characterist ics with rich bacilloscopy (sub-polar lepromatous); 2) these patients are more prone to hosting "persisters" that may eventually multiply and give rise to type I reaction; 3) the alternate type 1 and type 2 reactional episodes may indicate the role of the cellular immunity on development of the ENL episode, in which the granulomatous reaction would break down the specific regressive infiltrates exposing intracellular antigens. In face of the humoral hypersensitivity status, there would be deposition of immune complexes which would trigger an acute inflammatory reaction; 4) releasing the patient from MDT does not mean he is cured of leprosy. |
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Type I and type II reactions in a patient with ten years of follow-upPaciente com reação tipo I e tipo II e dez anos de seguimentoSurto reacional dimorfoEritema nodoso hansênicoTinea corporisType I reactiontype II reactionTinea corporisIt is reported the case of a 52 year-old man who had presented signs and symptoms of multibacillary leprosy for 20 years, but sought for treatment for his disease only fiveyears after the first onset while presenting ENL with joint involvement. During the treatment (MDT-MB) the patient continued to present ENH episodes and this situation persisted even after he was released from treatment. These ENL episodes occurred alternated or concomitantly with type 1 reactional episodes (Reversal Reaction) which defined him as a borderline case. He remained like that for 10 years, presenting spleenomegaly and hypersplenism signs in one occasion. He improved only after viable bacilli were detected leading to re-administration of the MDT. The discussion of the case emphasizes some interesting aspects of the evolution of the case: 1) delayed diagnosis leading borderline patients to acquire lepromatous characterist ics with rich bacilloscopy (sub-polar lepromatous); 2) these patients are more prone to hosting "persisters" that may eventually multiply and give rise to type I reaction; 3) the alternate type 1 and type 2 reactional episodes may indicate the role of the cellular immunity on development of the ENL episode, in which the granulomatous reaction would break down the specific regressive infiltrates exposing intracellular antigens. In face of the humoral hypersensitivity status, there would be deposition of immune complexes which would trigger an acute inflammatory reaction; 4) releasing the patient from MDT does not mean he is cured of leprosy.Relata-se o caso de um indivíduo do sexo masculino, de 52 anos de idade, que desde 20 anos atrás vinha apresentando sinais e sintomas de hanseníase multibacilar, mas só procurou tratamento após 5 anos, quando apresentava manifestações de Eritema Nodoso Hansênico (ENH - Reação tipo 1) inclusive com comprometimento articular. Instalado o tratamento (PQT/MB) o paciente passou a apresentar episódios de ENH, que se continuaram após a alta medicamentosa alternando-se ou em concomitância com episódios de reação tipo 1 (reação reversa) o que o definiu como um dimorfo. Assim permaneceu quase 10 anos, tendo apresentado, por a l g um t emp o , e s p l en ome ga l i a e s i na i s d e hiperesplenismo. Só melhorou, quando a detecção de bacilos viáveis levou à reinstalação da PQT. A discussão do caso ressalta alguns aspectos interessantes desta evolução: 1) a demora no diagnóstico leva pacientes dimorfos a adquirirem características virchovianas com rica baciloscopia (virchovianos sub-polares); 2) estes pacientes tem maior possibilidade de albergarem bacilos persistentes que eventualmente se multiplicam e estimulam reações tipo 1; 3) a alternância de reações tipo 1 e tipo 2 pode indicar a participação da imunidade celular no desencadeamento do ENH, onde a reação granulomatosa romperia os infiltrados específicos regressivos, expondo antígenos intracelulares. Frente ao estado de hipersensibilidade humoral, haveria deposição de complexos imunes e desencadeamento de reação inflamatória aguda; 4) a alta da PQT nãosignifica cura da hanseníase.Instituto Lauro de Souza Lima da Secretaria de Estado da Saúde de São Paulo2002-11-30info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionAvaliado pelos paresapplication/pdfhttps://periodicos.saude.sp.gov.br/hansenologia/article/view/3641810.47878/hi.2002.v27.36418Hansenologia Internationalis: leprosy and other infectious diseases; Vol. 27 No. 2 (2002); 105-111Hansenologia Internationalis: hanseníase e outras doenças infecciosas; v. 27 n. 2 (2002); 105-1111982-5161reponame:Hansenologia Internationalis (Online)instname:Instituto Lauro de Souza Lima (ILSL)instacron:ILSLporhttps://periodicos.saude.sp.gov.br/hansenologia/article/view/36418/34692https://creativecommons.org/licenses/by/4.0info:eu-repo/semantics/openAccessMartelli, Antonio Carlos CeribelliFleury, Raul NegrãoOpromolla , Diltor Vladimir Araújo2023-09-01T13:20:35Zoai:ojs.periodicos.saude.sp.gov.br:article/36418Revistahttps://periodicos.saude.sp.gov.br/hansenologiaPRIhttps://periodicos.saude.sp.gov.br/hansenologia/oaihansen_int@ilsl.br || hansenologia.internationalis@gmail.com || periodicossp@saude.sp.gov.br1982-51610100-3283opendoar:2023-09-01T13:20:35Hansenologia Internationalis (Online) - Instituto Lauro de Souza Lima (ILSL)false |
dc.title.none.fl_str_mv |
Type I and type II reactions in a patient with ten years of follow-up Paciente com reação tipo I e tipo II e dez anos de seguimento |
title |
Type I and type II reactions in a patient with ten years of follow-up |
spellingShingle |
Type I and type II reactions in a patient with ten years of follow-up Martelli, Antonio Carlos Ceribelli Surto reacional dimorfo Eritema nodoso hansênico Tinea corporis Type I reaction type II reaction Tinea corporis |
title_short |
Type I and type II reactions in a patient with ten years of follow-up |
title_full |
Type I and type II reactions in a patient with ten years of follow-up |
title_fullStr |
Type I and type II reactions in a patient with ten years of follow-up |
title_full_unstemmed |
Type I and type II reactions in a patient with ten years of follow-up |
title_sort |
Type I and type II reactions in a patient with ten years of follow-up |
author |
Martelli, Antonio Carlos Ceribelli |
author_facet |
Martelli, Antonio Carlos Ceribelli Fleury, Raul Negrão Opromolla , Diltor Vladimir Araújo |
author_role |
author |
author2 |
Fleury, Raul Negrão Opromolla , Diltor Vladimir Araújo |
author2_role |
author author |
dc.contributor.author.fl_str_mv |
Martelli, Antonio Carlos Ceribelli Fleury, Raul Negrão Opromolla , Diltor Vladimir Araújo |
dc.subject.por.fl_str_mv |
Surto reacional dimorfo Eritema nodoso hansênico Tinea corporis Type I reaction type II reaction Tinea corporis |
topic |
Surto reacional dimorfo Eritema nodoso hansênico Tinea corporis Type I reaction type II reaction Tinea corporis |
description |
It is reported the case of a 52 year-old man who had presented signs and symptoms of multibacillary leprosy for 20 years, but sought for treatment for his disease only fiveyears after the first onset while presenting ENL with joint involvement. During the treatment (MDT-MB) the patient continued to present ENH episodes and this situation persisted even after he was released from treatment. These ENL episodes occurred alternated or concomitantly with type 1 reactional episodes (Reversal Reaction) which defined him as a borderline case. He remained like that for 10 years, presenting spleenomegaly and hypersplenism signs in one occasion. He improved only after viable bacilli were detected leading to re-administration of the MDT. The discussion of the case emphasizes some interesting aspects of the evolution of the case: 1) delayed diagnosis leading borderline patients to acquire lepromatous characterist ics with rich bacilloscopy (sub-polar lepromatous); 2) these patients are more prone to hosting "persisters" that may eventually multiply and give rise to type I reaction; 3) the alternate type 1 and type 2 reactional episodes may indicate the role of the cellular immunity on development of the ENL episode, in which the granulomatous reaction would break down the specific regressive infiltrates exposing intracellular antigens. In face of the humoral hypersensitivity status, there would be deposition of immune complexes which would trigger an acute inflammatory reaction; 4) releasing the patient from MDT does not mean he is cured of leprosy. |
publishDate |
2002 |
dc.date.none.fl_str_mv |
2002-11-30 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Avaliado pelos pares |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://periodicos.saude.sp.gov.br/hansenologia/article/view/36418 10.47878/hi.2002.v27.36418 |
url |
https://periodicos.saude.sp.gov.br/hansenologia/article/view/36418 |
identifier_str_mv |
10.47878/hi.2002.v27.36418 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
https://periodicos.saude.sp.gov.br/hansenologia/article/view/36418/34692 |
dc.rights.driver.fl_str_mv |
https://creativecommons.org/licenses/by/4.0 info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
https://creativecommons.org/licenses/by/4.0 |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Instituto Lauro de Souza Lima da Secretaria de Estado da Saúde de São Paulo |
publisher.none.fl_str_mv |
Instituto Lauro de Souza Lima da Secretaria de Estado da Saúde de São Paulo |
dc.source.none.fl_str_mv |
Hansenologia Internationalis: leprosy and other infectious diseases; Vol. 27 No. 2 (2002); 105-111 Hansenologia Internationalis: hanseníase e outras doenças infecciosas; v. 27 n. 2 (2002); 105-111 1982-5161 reponame:Hansenologia Internationalis (Online) instname:Instituto Lauro de Souza Lima (ILSL) instacron:ILSL |
instname_str |
Instituto Lauro de Souza Lima (ILSL) |
instacron_str |
ILSL |
institution |
ILSL |
reponame_str |
Hansenologia Internationalis (Online) |
collection |
Hansenologia Internationalis (Online) |
repository.name.fl_str_mv |
Hansenologia Internationalis (Online) - Instituto Lauro de Souza Lima (ILSL) |
repository.mail.fl_str_mv |
hansen_int@ilsl.br || hansenologia.internationalis@gmail.com || periodicossp@saude.sp.gov.br |
_version_ |
1796797581394706432 |