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

Maria Rita Parise-Fortes1,2, Joel Carlos Lastória1, Silvio Alencar Marques1, Maria Stella Ayres Putinatti1, Hamilton Ometto Stolf1, Mariângela Ester Alencar Marques3, Vidal Haddad1
1Department of Dermatology, Botucatu Medical School, São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brasil
2Departamento de Dermatologia e Radioterapia, Faculdade de Medicina de Botucatu, UNESP, Botucatu, Brasil
3Department of Pathology, Botucatu Medical School, São Paulo State University (UNESP – Univ Estadual Paulista), Botucatu, Brazil

Tóm tắt

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.

Tài liệu tham khảo

Yamamura M, Uyemura K, Deans RJ, Weinberg K, Rea TH, Bloom BR, Modlin RL: Defining protective responses to pathogens: cytokine profiles in leprosy lesions. Science 1991, 254(5029):277–279. Foss NT: Hanseníase: aspectos clínicos, imunológicos e terapêuticos. An Bras Dermatol 1999, 74(2):113–119. Centers for Disease Control and Prevention: Reported Tuberculosis in the United States, 2006. Atlanta, US: Department of Health and Human Services, CDC; 2007. http://www.cdc.gov/tb/statistics/reports/surv2006/pdf/FullReport.pdf World Health Organization: Tuberculosis – Global Facts 2011/2102. Geneva: WHO Stop TBDep; ᅟ. http://www.who.int/tb/publications/2011/factsheet_tb_2011.pdf Vynnycky E, Fine PE: Lifetime risks, incubation period, and serial interval of tuberculosis. Am J Epidemiol 2000, 152(3):247–263. Borgdorff MW, Sebek M, Geskus RB, Kremer K, Kalisvaart N, Van Soolingen D: The incubation period distribution of tuberculosis estimated with a molecular epidemiological approach. Int J Epidemiol 2011, 40(4):964–970. Worobec SM: Treatment of Leprosy/Hansen’s disease in the early 21st century. Dermatol Ther 2009, 22(6):518–537. Ottenhoff THM: New pathways of protective and pathological host defense to mycobacteria. Trends Microbiol 2012, 20(9):419–428. World Health Organization: Tuberculosis - The Essentials. 4th edition. Edited by: Raviglione MC. Geneva, Switzerland: World Health Organization; 2010. http://www.who.int/tb/features_archive/the_essentials/en/ Wells CD, Cegielski JP, Nelson LJ, Laserson KF, Holtz TH, Finalay A, Castro KG, Weyer K: HIV infection and multidrug – resistant tuberculosis: the perfect storm. J Infect Dis 2007, 15(196):S86-S107. Handog EB, Gabriel TG, Pineda RT: Management of cutaneous tuberculosis. Dermatol Ther 2008, 21(3):154–161. Kamil S, Aithal V, Kumaran MS, Abrahana A: Cutaneous tuberculosis of the pinna: a report of two cases. Int J Dermatol 2013, 52(6):714–717. Yasmeen N, Kanjee A: Cutaneous tuberculosis: a three year prospective study. J Pak Med Assoc 2005, 55(1):10–12. Akgun E, Tekin F, Ersin S, Osmanoglu H: Isolated perianal tuberculosis. Neth J Med 2005, 63(3):115–117. Ghiya R, Sharma A, Marfatia YS: Perianal ulcer as a marker of tuberculosis in the HIV infected. Indian J Dermatol Venereol Leprol 2008, 74(4):386–388. Mathew S: Anal tuberculosis: report of a case and review of literature. Int J Surg 2008, 6(6):e36-e39. Trindade MAB, Miyamoto D, Benard G, Sakai-Valente NY, Vasconcelos DM, Naafs B: Leprosy and tuberculosis co-infection: clinical and immunological report of two cases and review of the literature. Am J Trop Med Hyg 2013, 88(2):236–240. Grace M, Shameemurahman : Coinfection of two age old diseases. Indian J Community Med 2011, 36(3):228–230. Delobel P, Launois P, Djossou F, Sainte-Marie D, Pradinaud R: American cutaneous leishmaniasis, lepromatous leprosy and pulmonary tuberculosis coinfection with downregulation of the T-helper 1 cell response. Clin Infect Dis 2003, 37(5):628–633. Trindade MAB, Manini MIP, Masetti JH, Leite MA, Takahashi MDF, Naafs B: Leprosy and HIV co-infection in five patients. Lepr Rev 2005, 76(2):162–166. Lockwood DN, Lambert SM: Human immunodeficiency virus and leprosy: an update. Dermatol Clin 2011, 29(1):125–128. Inamadar AC, Sampagavi VV: Concomitant occurrence of leprosy, cutaneous tuberculosis and pulmonary tuberculosis – a case report. Lepr Rev 1994, 65(3):282–284. Prasad R, Verma SK, Singh R, Hosmane G: Concomitant pulmonary tuberculosis and borderline leprosy with type-II lepra reaction in single patient. Lung India 2010, 27(1):19–23. Loh E, Maverakis E, Konia T, Noll E: Lepromatous leprosy in a 26 year-old man with concurrent disseminated tuberculosis. Arch Dermatol 2012, 148(9):1096–1097. Sampaio LH, Stefani MAM, Oliveira RM, Sousa ALM, Ireton GC, Reed SG, Duthie MS: Immunologically reactive M. leprae antigens with relevance to diagnosis and vaccine development. BMC Infect Dis 2011, 11: 26. doi:10.1186/1471–2334–11–26 Salgado CG, Barreto JG: Leprosy transmission: still a challenge. Acta Derm Venereol 2012, 92(3):335. Negrete V, Ida J, Dillig G, Zohrabian N, Feldman J: Concurrent Hansen disease and pulmonary tuberculosis. J Am Dermatol 2011, 64(5):1001–1003. O’Garra A, Redford PS, McNab FW, Bloom CI, Wilkinson RJ, Berry MPR: The immune response in tuberculosis. Annu Rev Immunol 2013, 31: 475–527. Sturgill-Koszycki S, Schlesinger PH, Chakraborty P, Haddix PL, Collins HL, Fok AK, Allen RD, Gluck SL, Heuser J, Russell DG: Lack of acidification in Mycobacterium phagosomes produced by exclusion of the vesicular proton-ATPase. Science 1994, 263(5147):678–681. Pieroni F, Stracieri ABPL, Moraes DA, Paton EJA, Saggioro FP, Barros GM, Barros JC, Oliveira MCB, Coutinho MA, Castro NS, Vigoritto AC, Trabasso P, Souza CA, de Souza MP, Mauad MA, Colturato VAR, Simões BP, Foss NP, Voltarelli JC: Six cases of leprosy associated with allogeneic hematopoietic SCT. Bone Marrow Transpl 2007, 40(9):859–863. Shih HC, Hung TW, Lian JD, Tsao SM, Hsieh NK, Yang JH: Leprosy in a renal transplant recipient: a case report and literature review. J Dermatol 2005, 32(8):661–663. Scollard DM, Joyce MP, Gillis TP: Development of leprosy and type 1 leprosy reactions after treatment with infliximab: a report of 2 cases. Clin Infect Dis 2006, 43(2):19–22. Bravo FG, Gotuzzo E: Cutaneous tuberculosis. Clin Dermatol 2007, 25(2):173–180. Sehgal VN, Verma P, Bhattacharya SN, Sharma S, Singh N, Verma N: Cutaneous tuberculosis: a diagnostic dilemma. Skinmed 2012, 10(1):28–33.