“Itching” lepromatous leprosy in an elderly man: the importance of dermatologic and neurological examination and the diagnosis’ suspicion.
Autor(a) principal: | |
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Data de Publicação: | 2010 |
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/35124 |
Resumo: | Introduction: Polar lepromatous leprosy (LLp) is a clinical form which the diagnosis is very difficult in early stages, since nerve damage is not seen, and there are not visible plaques. We report a case with atypical symptoms in an elderly man: the ruritus. Case report: Male, 81 years, caucasian, coming from Iti- Male, 81 years, caucasian, coming from Itirapina - SP, referred to the dermatological service with the diagnosis of “allergy”, reported that two years ago noted the presence of papules, plaques and nodules on the body, associated with intense pruritus, more pronounced on the lesions. Physical examination revealed diffuse livedo (which was not seen only on the area of the Michaelis polygon), as weel as acrocyanosis, madarosis, papules, plaques, and erythematous-violaceous nodules on the abdomen, perimamilar region, legs and buttocks. On neurological examination it was noted nerves thickening: both ulnars, radials, tibials, and left fibular. He had no ulnar claw and sensitivity test monofilaments showed no loss of tactile sensitivity on the hands, or even loss of protective sensitivity on the feet. Bacilloscopy of smear from index points ranged from 3-5+, with morphological index = 3%. The Mitsuda test was negative, and biopsy of the lesions showed LL. Discussion: The LLp is the most infectious form of leprosy, and it is the most difficult to make diagnosis, mainly when do not suspected. The virtual lack of immunity allows the bacilli proliferate in the nerve cell for nearly a decade, on average, without typical symptoms (lumps, “stains”, neuritis or deformities). Although atypical symptom, mucocutaneous xerosis can cause itching, and neurovascular involvement leads to livedo reticularis and acrocyanosis, signs that should alert the clinician to the diagnosis, especially if there is presence of spared areas of infiltration / livedo, like armpits, scalp and Michaelis polygon, very suggestive of LL. The neurological examination always shows diffuse thickening neural and skin smear is always very positive. |
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“Itching” lepromatous leprosy in an elderly man: the importance of dermatologic and neurological examination and the diagnosis’ suspicion.Hanseníase virchowiana "pruriginosa" em idoso: a importância do exame dermatoneurológico e suspeição diagnósticaIntroduction: Polar lepromatous leprosy (LLp) is a clinical form which the diagnosis is very difficult in early stages, since nerve damage is not seen, and there are not visible plaques. We report a case with atypical symptoms in an elderly man: the ruritus. Case report: Male, 81 years, caucasian, coming from Iti- Male, 81 years, caucasian, coming from Itirapina - SP, referred to the dermatological service with the diagnosis of “allergy”, reported that two years ago noted the presence of papules, plaques and nodules on the body, associated with intense pruritus, more pronounced on the lesions. Physical examination revealed diffuse livedo (which was not seen only on the area of the Michaelis polygon), as weel as acrocyanosis, madarosis, papules, plaques, and erythematous-violaceous nodules on the abdomen, perimamilar region, legs and buttocks. On neurological examination it was noted nerves thickening: both ulnars, radials, tibials, and left fibular. He had no ulnar claw and sensitivity test monofilaments showed no loss of tactile sensitivity on the hands, or even loss of protective sensitivity on the feet. Bacilloscopy of smear from index points ranged from 3-5+, with morphological index = 3%. The Mitsuda test was negative, and biopsy of the lesions showed LL. Discussion: The LLp is the most infectious form of leprosy, and it is the most difficult to make diagnosis, mainly when do not suspected. The virtual lack of immunity allows the bacilli proliferate in the nerve cell for nearly a decade, on average, without typical symptoms (lumps, “stains”, neuritis or deformities). Although atypical symptom, mucocutaneous xerosis can cause itching, and neurovascular involvement leads to livedo reticularis and acrocyanosis, signs that should alert the clinician to the diagnosis, especially if there is presence of spared areas of infiltration / livedo, like armpits, scalp and Michaelis polygon, very suggestive of LL. The neurological examination always shows diffuse thickening neural and skin smear is always very positive.Introdução: A hanseníase virchowiana (MHV) polar é forma clínica de diagnóstico mais difícil nas fases iniciais, já que o comprometimento neurológico é tardio e não há presença de placas. Relata-se um caso com sintoma atípico em idoso: o prurido. Relato de caso: Homem, 81 anos, branco, procedente de Itirapina - SP, encaminhado ao serviço de referência com hipótese diagnóstica de “alergia”, relatava que há dois anos notou a presença de pápulas, placas e nódulos em corpo, associado a prurido intenso generalizado, mais pronunciado nas lesões. Ao exame físico, havia livedo reticular difuso que poupava a área do polígono de Michaelis, acrocianose, madarose, pápulas, placas e nódulos eritêmato-violáceos em abdome, região perimamilar, membros inferiores e região glútea. Ao exame neurológico, notou-se espessamento de nervos ulnares, radiais, tibiais e fibular esquerdo. Não apresentava garra ulnar e o teste de sensibilidade com monofilamentos não demonstrou perda da sensibilidade tátil nas mãos ou protetora nos pés. A baciloscopia de pontos índices variou entre de 3 a 5+, com índice morfológico de 3%. O teste de Mitsuda foi negativo, e a biópsia de uma das lesões evidenciou MHV. Discussão: A MHV polar constitui-se na forma mais bacilífera e de maior dificuldade diagnóstica, quando não se faz a suspeição. A virtual ausência de imunidade permite que o bacilo prolifere na célula nervosa por quase uma década, em média, sem que haja sintomas característicos (nódulos, “manchas”, neurite ou deformidades). Embora seja sintoma atípico, a xerose cutâneo-mucosa pode causar prurido, e o comprometimento neurovascular leva ao livedo reticular e acrocianose, sinais que devem alertar o clínico para a suspeita diagnóstica, principalmente se há presença de áreas poupadas da infiltração/livedo, como axilas, couro cabeludo e polígono de Michaelis, muito sugestivas de MHV. O exame neurológico sempre demonstra espessamento neural difuso, e a baciloscopia é sempre ricamente positiva.Instituto Lauro de Souza Lima da Secretaria de Estado da Saúde de São Paulo2010-06-30info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionAvaliado pelos paresapplication/pdfhttps://periodicos.saude.sp.gov.br/hansenologia/article/view/3512410.47878/hi.2010.v35.35124Hansenologia Internationalis: leprosy and other infectious diseases; Vol. 35 No. 1 (2010); 57-62Hansenologia Internationalis: hanseníase e outras doenças infecciosas; v. 35 n. 1 (2010); 57-621982-5161reponame:Hansenologia Internationalis (Online)instname:Instituto Lauro de Souza Lima (ILSL)instacron:ILSLporhttps://periodicos.saude.sp.gov.br/hansenologia/article/view/35124/33600https://creativecommons.org/licenses/by/4.0info:eu-repo/semantics/openAccessTeixeira, Leandra OliveiraSilva, Carlos Maximiliano Gaspar Carvalho HeilMartins, Ana Luiza Grizzo PeresBarroso, Lívia Ariane LopesBarreto, Jaison AntonioSoares, Cleverson Teixeira2023-02-13T15:27:50Zoai:ojs.periodicos.saude.sp.gov.br:article/35124Revistahttps://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:2023-02-13T15:27:50Hansenologia Internationalis (Online) - Instituto Lauro de Souza Lima (ILSL)false |
dc.title.none.fl_str_mv |
“Itching” lepromatous leprosy in an elderly man: the importance of dermatologic and neurological examination and the diagnosis’ suspicion. Hanseníase virchowiana "pruriginosa" em idoso: a importância do exame dermatoneurológico e suspeição diagnóstica |
title |
“Itching” lepromatous leprosy in an elderly man: the importance of dermatologic and neurological examination and the diagnosis’ suspicion. |
spellingShingle |
“Itching” lepromatous leprosy in an elderly man: the importance of dermatologic and neurological examination and the diagnosis’ suspicion. Teixeira, Leandra Oliveira |
title_short |
“Itching” lepromatous leprosy in an elderly man: the importance of dermatologic and neurological examination and the diagnosis’ suspicion. |
title_full |
“Itching” lepromatous leprosy in an elderly man: the importance of dermatologic and neurological examination and the diagnosis’ suspicion. |
title_fullStr |
“Itching” lepromatous leprosy in an elderly man: the importance of dermatologic and neurological examination and the diagnosis’ suspicion. |
title_full_unstemmed |
“Itching” lepromatous leprosy in an elderly man: the importance of dermatologic and neurological examination and the diagnosis’ suspicion. |
title_sort |
“Itching” lepromatous leprosy in an elderly man: the importance of dermatologic and neurological examination and the diagnosis’ suspicion. |
author |
Teixeira, Leandra Oliveira |
author_facet |
Teixeira, Leandra Oliveira Silva, Carlos Maximiliano Gaspar Carvalho Heil Martins, Ana Luiza Grizzo Peres Barroso, Lívia Ariane Lopes Barreto, Jaison Antonio Soares, Cleverson Teixeira |
author_role |
author |
author2 |
Silva, Carlos Maximiliano Gaspar Carvalho Heil Martins, Ana Luiza Grizzo Peres Barroso, Lívia Ariane Lopes Barreto, Jaison Antonio Soares, Cleverson Teixeira |
author2_role |
author author author author author |
dc.contributor.author.fl_str_mv |
Teixeira, Leandra Oliveira Silva, Carlos Maximiliano Gaspar Carvalho Heil Martins, Ana Luiza Grizzo Peres Barroso, Lívia Ariane Lopes Barreto, Jaison Antonio Soares, Cleverson Teixeira |
description |
Introduction: Polar lepromatous leprosy (LLp) is a clinical form which the diagnosis is very difficult in early stages, since nerve damage is not seen, and there are not visible plaques. We report a case with atypical symptoms in an elderly man: the ruritus. Case report: Male, 81 years, caucasian, coming from Iti- Male, 81 years, caucasian, coming from Itirapina - SP, referred to the dermatological service with the diagnosis of “allergy”, reported that two years ago noted the presence of papules, plaques and nodules on the body, associated with intense pruritus, more pronounced on the lesions. Physical examination revealed diffuse livedo (which was not seen only on the area of the Michaelis polygon), as weel as acrocyanosis, madarosis, papules, plaques, and erythematous-violaceous nodules on the abdomen, perimamilar region, legs and buttocks. On neurological examination it was noted nerves thickening: both ulnars, radials, tibials, and left fibular. He had no ulnar claw and sensitivity test monofilaments showed no loss of tactile sensitivity on the hands, or even loss of protective sensitivity on the feet. Bacilloscopy of smear from index points ranged from 3-5+, with morphological index = 3%. The Mitsuda test was negative, and biopsy of the lesions showed LL. Discussion: The LLp is the most infectious form of leprosy, and it is the most difficult to make diagnosis, mainly when do not suspected. The virtual lack of immunity allows the bacilli proliferate in the nerve cell for nearly a decade, on average, without typical symptoms (lumps, “stains”, neuritis or deformities). Although atypical symptom, mucocutaneous xerosis can cause itching, and neurovascular involvement leads to livedo reticularis and acrocyanosis, signs that should alert the clinician to the diagnosis, especially if there is presence of spared areas of infiltration / livedo, like armpits, scalp and Michaelis polygon, very suggestive of LL. The neurological examination always shows diffuse thickening neural and skin smear is always very positive. |
publishDate |
2010 |
dc.date.none.fl_str_mv |
2010-06-30 |
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/35124 10.47878/hi.2010.v35.35124 |
url |
https://periodicos.saude.sp.gov.br/hansenologia/article/view/35124 |
identifier_str_mv |
10.47878/hi.2010.v35.35124 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
https://periodicos.saude.sp.gov.br/hansenologia/article/view/35124/33600 |
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. 35 No. 1 (2010); 57-62 Hansenologia Internationalis: hanseníase e outras doenças infecciosas; v. 35 n. 1 (2010); 57-62 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_ |
1796797578818355200 |