Recidiva ou reação reversa?
Autor(a) principal: | |
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Data de Publicação: | 1994 |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Hansenologia Internationalis (Online) |
Texto Completo: | https://periodicos.saude.sp.gov.br/hansenologia/article/view/35458 |
Resumo: | A woman, eighty eight years old, was admitted in the "Lauro de Souza Lima" Institute presenting acute, large, erithematous "BT' plaques in her body. She was previously admitted at the Institute in 1935, forty years ago, presenting similaralthough less intense lesions that disappeared spontaneously after 2 years. In the first reactional episode bacilli were found only in a linphnode punction. During the second reaction bacilli could be found in all lesions. Histopathology showed tuberculoid granulomas in both episodes. Usually, this sort of acute phenomenon has a duration of several months and the gap between the first and the next is from 2-3 months to several years (5 years in a case described by Wade). In our case the interval between the two eruptions was extremely large, 40 years! We may consider in this case the possibility of a reinfection but it is difficult to admit this fact due to the type of the new lesions observed and the appearance of some lesions near the site of the former ones. We believe that it is easier to accept the hypothesis of a relapse. In this sense, we believe that persisting bacilli multiply after 40 years, are destroyed, in part or totally, by the immune system and resultant antigens elicit a delayed hypersensitivity reaction presenting acute cutaneous lesions as clinical expression. If this is true, we can extrapolate this fact to explain all the reversal reactions °cuffing before, during and after treatment. Thus, after completion of treatment, there is no need to differentiate between reversal reaction and relapse and, moreover, it will be necessary to reappraise the effect of chemoterapy in such cases. |
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Recidiva ou reação reversa?reação reversarecidivareinfecçãoreversal reactionrelapserein feccionA woman, eighty eight years old, was admitted in the "Lauro de Souza Lima" Institute presenting acute, large, erithematous "BT' plaques in her body. She was previously admitted at the Institute in 1935, forty years ago, presenting similaralthough less intense lesions that disappeared spontaneously after 2 years. In the first reactional episode bacilli were found only in a linphnode punction. During the second reaction bacilli could be found in all lesions. Histopathology showed tuberculoid granulomas in both episodes. Usually, this sort of acute phenomenon has a duration of several months and the gap between the first and the next is from 2-3 months to several years (5 years in a case described by Wade). In our case the interval between the two eruptions was extremely large, 40 years! We may consider in this case the possibility of a reinfection but it is difficult to admit this fact due to the type of the new lesions observed and the appearance of some lesions near the site of the former ones. We believe that it is easier to accept the hypothesis of a relapse. In this sense, we believe that persisting bacilli multiply after 40 years, are destroyed, in part or totally, by the immune system and resultant antigens elicit a delayed hypersensitivity reaction presenting acute cutaneous lesions as clinical expression. If this is true, we can extrapolate this fact to explain all the reversal reactions °cuffing before, during and after treatment. Thus, after completion of treatment, there is no need to differentiate between reversal reaction and relapse and, moreover, it will be necessary to reappraise the effect of chemoterapy in such cases.É descrito o caso de uma mulher de 88 anos, portadora de hanseníase BT que foi internada no Instituto "Lauro de Souza Lima", apresentando grandes placas eritematosas em todo o corpo que apareceram abruptamente. Ela, em 1935, já havia sido internada neste Instituto apresentando um quadro semelhante, menos intenso e que desapareceu espontâneamente em 2 anos. Na primeira vez puderam ser demonstrados bacilos somente em uma pun cão de linfonodo, mas no segundo surto foram visto bacilos em todas as lesões. Em ambas as ocasiões o exame histopatológico das lesões revelou a presença de granulomas tuberculoides. Geralmente este tipo de fenômeno reacional tem uma duração de vários meses e o intervalo entre um e outro pode oscilar entre dois a tres meses até uns poucos anos(cinco anos em um caso descrito por Wade). Em nosso caso o intervalo entre os dois surtos reacionais foi extremamente longo, 40 anos.Achamos dificil admitir que o too de fenômeno reacional descrito seja devido a uma rein fecção, devido ao too de lesões observadas e o aparecimento de algumas delas junto ao local das lesões regredidas do primeiro surto. Consideramos mais provável que o aparecimento do segundo surto neste caso, está relacionado com a multiplicação de bacilos persistentes que foram destruidos pelo sistema imune, liberando antígenos que desencadearam uma reação de hipersensibilidade retardada cuja expressão clínica foram as lesões cutâneas reacionaisisso poderia explicar qualquer outro surto agudo rotulado como reação reversa que ocorra antes, durante ou após a interrupção da terapêutica. Desta maneira não haveria necessidade em diferenciar reação reversa de recidiva após o término do tratamento e seria então importante reavaliar o real efeito da quimioterapia nesses casos reacionais.Instituto Lauro de Souza Lima da Secretaria de Estado da Saúde de São Paulo1994-06-30info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionAvaliado pelos paresapplication/pdfhttps://periodicos.saude.sp.gov.br/hansenologia/article/view/3545810.47878/hi.1994.v19.35458Hansenologia Internationalis: leprosy and other infectious diseases; Vol. 19 No. 1 (1994); 10-16Hansenologia Internationalis: hanseníase e outras doenças infecciosas; v. 19 n. 1 (1994); 10-161982-5161reponame:Hansenologia Internationalis (Online)instname:Instituto Lauro de Souza Lima (ILSL)instacron:ILSLporhttps://periodicos.saude.sp.gov.br/hansenologia/article/view/35458/33881Opromolla, Diltor V.A.info:eu-repo/semantics/openAccess2021-06-06T01:00:39Zoai:ojs.periodicos.saude.sp.gov.br:article/35458Revistahttps://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:2021-06-06T01:00:39Hansenologia Internationalis (Online) - Instituto Lauro de Souza Lima (ILSL)false |
dc.title.none.fl_str_mv |
Recidiva ou reação reversa? |
title |
Recidiva ou reação reversa? |
spellingShingle |
Recidiva ou reação reversa? Opromolla, Diltor V.A. reação reversa recidiva reinfecção reversal reaction relapse rein feccion |
title_short |
Recidiva ou reação reversa? |
title_full |
Recidiva ou reação reversa? |
title_fullStr |
Recidiva ou reação reversa? |
title_full_unstemmed |
Recidiva ou reação reversa? |
title_sort |
Recidiva ou reação reversa? |
author |
Opromolla, Diltor V.A. |
author_facet |
Opromolla, Diltor V.A. |
author_role |
author |
dc.contributor.author.fl_str_mv |
Opromolla, Diltor V.A. |
dc.subject.por.fl_str_mv |
reação reversa recidiva reinfecção reversal reaction relapse rein feccion |
topic |
reação reversa recidiva reinfecção reversal reaction relapse rein feccion |
description |
A woman, eighty eight years old, was admitted in the "Lauro de Souza Lima" Institute presenting acute, large, erithematous "BT' plaques in her body. She was previously admitted at the Institute in 1935, forty years ago, presenting similaralthough less intense lesions that disappeared spontaneously after 2 years. In the first reactional episode bacilli were found only in a linphnode punction. During the second reaction bacilli could be found in all lesions. Histopathology showed tuberculoid granulomas in both episodes. Usually, this sort of acute phenomenon has a duration of several months and the gap between the first and the next is from 2-3 months to several years (5 years in a case described by Wade). In our case the interval between the two eruptions was extremely large, 40 years! We may consider in this case the possibility of a reinfection but it is difficult to admit this fact due to the type of the new lesions observed and the appearance of some lesions near the site of the former ones. We believe that it is easier to accept the hypothesis of a relapse. In this sense, we believe that persisting bacilli multiply after 40 years, are destroyed, in part or totally, by the immune system and resultant antigens elicit a delayed hypersensitivity reaction presenting acute cutaneous lesions as clinical expression. If this is true, we can extrapolate this fact to explain all the reversal reactions °cuffing before, during and after treatment. Thus, after completion of treatment, there is no need to differentiate between reversal reaction and relapse and, moreover, it will be necessary to reappraise the effect of chemoterapy in such cases. |
publishDate |
1994 |
dc.date.none.fl_str_mv |
1994-06-30 |
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/35458 10.47878/hi.1994.v19.35458 |
url |
https://periodicos.saude.sp.gov.br/hansenologia/article/view/35458 |
identifier_str_mv |
10.47878/hi.1994.v19.35458 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
https://periodicos.saude.sp.gov.br/hansenologia/article/view/35458/33881 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
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. 19 No. 1 (1994); 10-16 Hansenologia Internationalis: hanseníase e outras doenças infecciosas; v. 19 n. 1 (1994); 10-16 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_ |
1796797579672944640 |