Leg ulcer in lepromatous leprosy - Case report

Fernandes, Tânia Rita Moreno de Oliveira; Santos, Talita Suzany Siqueira dos; Lopes, Ramon Rodrigues de Macedo

doi:10.1590/abd1806-4841.20164149

Cited by 5 publications

(4 citation statements)

References 6 publications

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“…It is possible that a high bacillary load within macrophages may lead to rupture and ulceration in both diffuse infiltration and Hansenomas in LL. 8 The importance is that in this subset of patients with spontaneous ulceration and nodular or diffuse LL, a correct diagnosis will avoid inadvertent use of steroids.…”

Section: Discussionmentioning

confidence: 99%

Unusual non-trophic ulcerations in leprosy: A case series of 17 patients

et al. 2021

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Non-neuropathic ulcers in leprosy patients are infrequently seen, and atypical presentations are prone to misdiagnosis. We evaluated diagnosed cases of leprosy between January 2017 and January 2020 for the presence of cutaneous ulceration, Ridley–Jopling subtype of leprosy, reactions and histologic features of these ulcerations. Treatment was given as WHO recommended multi-bacillary multi-drug therapy. We found 17/386 leprosy patients with non-neuropathic ulcers. We describe three causes – spontaneous cutaneous ulceration in lepromatous leprosy (one nodular and one diffuse), lepra reactions (five patients with type 1; nine with type 2, further categorised into ulcerated Sweet syndrome-like who also had pseudoepitheliomatous hyperplasia, pustulo-necrotic and necrotic erythema nodosum leprosum) and Lucio phenomenon (one patient). Our series draws attention towards the different faces of non-neuropathic ulcers in leprosy, including some atypical and novel presentations.

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Section: Discussionmentioning

confidence: 99%

Unusual non-trophic ulcerations in leprosy: A case series of 17 patients

et al. 2021

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“…Patients with leprosy rarely present ulcerated lesions; these can eventually appear during reactional sates, LP, or secondary to neuropathy, the latter particularly on the plantar surfaces [10]. In general, healing of the ulcerated neuropathic lesions is very slow, due to the vascular and neural disabilities that underlie these manifestations, requiring specific therapeutic interventions in addition to MDT-MB.…”

Section: Discussionmentioning

confidence: 99%

Ulcers in leprosy patients, an unrecognized clinical manifestation: a report of 8 cases

et al. 2019

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BackgroundLeprosy is a chronic granulomatous infection caused by Mycobacterium leprae. It is a polymorphic disease with a wide range of cutaneous and neural manifestations. Ulcer is not a common feature in leprosy patients, except during reactional states, Lucio’s phenomenon (LP), or secondary to neuropathies.Cases presentationWe report eight patients with multibacillary leprosy who presented specific skin ulcers as part of their main leprosy manifestation. Ulcers were mostly present on lower limbs (eight patients), followed by the upper limbs (three patients), and the abdomen (one patient). Mean time from onset of skin ulcers to diagnosis of leprosy was 17.4 months: all patients were either misdiagnosed or had delayed diagnosis, with seven of them presenting grade 2 disability by the time of the diagnosis. Reactional states, LP or neuropathy as potential causes of ulcers were ruled out. Biopsy of the ulcer was available in seven patients: histopathology showed mild to moderate lympho-histiocytic infiltrate with vacuolized histiocytes and intact isolated and grouped acid-fast bacilli. Eosinophils, vasculitis, vasculopathy or signs of chronic venous insufficiency were not observed. Skin lesions improved rapidly after multidrug therapy, without any concomitant specific treatment for ulcers.ConclusionsThis series of cases highlights the importance of recognizing ulcers as a specific cutaneous manifestation of leprosy, allowing diagnosis and treatment of the disease, and therefore avoiding development of disabilities and persistence of the transmission chain of M. leprae.

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“…Ulkus trofik atau sering disebut juga sebagai ulkus plantaris, 11 menunjukkan ciri khas berupa hilangnya jaringan di bagian permukaan tubuh yang mengalami anestesi dan berkurangnya aliran darah. 12 Predileksi ulkus trofik kaki umumnya terdapat di bagian phalang proximal ibu jari kaki. 5 Ulkus ini cenderung mengalami kekambuhan meskipun sudah diobati.…”

Section: Gambar 3 Pengamatan Hari Ke-70unclassified

“…3 Ulkus trofik dapat terjadi pada kusta tipe pausibasilar (PB) maupun tipe multibasilar (MB). 12 Penyebab ulkus trofik umumnya akibat trauma dari luar pada kaki yang anestesi, 1 kemudian menimbulkan bula pada kulit, selanjutnya menjadi luka terbuka. Faktor lain yang dapat menyebabkan ulkus trofik adalah gangguan neurogenik misalnya pada neuropati diabetikum, spina bifida, alcoholic polyneuropathy, gangguan vaskular baik pada arteri misalnya peripheral vascular disease, arteriosklerosis, mikroangiopati pada diabetes, maupun pada vena misalnya venous statis ulcer.…”

Section: Gambar 3 Pengamatan Hari Ke-70unclassified

Modern Wound Dressing Pada Ulkus Trofik Pasien Kusta Tipe Lepromatosa

Cikutra¹,

Hergyana²,

Mayasari³

2019

MDVI

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Ulkus trofik merupakan salah satu bentuk deformitas kaki yang sering ditemukan pada pasien kusta dan dapat menyebabkan disabilitas pada sekitar 10% - 20% pasien kusta. Salah satu terapi ulkus trofik adalah menggunakan hydrocolloid dressing, yang merupakan modern wound dressing untuk merangsang penyembuhan dengan menyediakan lingkungan yang lembap dalam proses penyembuhan luka dan melindungi permukaan luka dari trauma atau kontaminasi bakteri. Dilaporkan sebuah kasus ulkus trofik pada seorang perempuan berusia 61 tahun dengan kusta tipe lepromatosa. Diagnosis ulkus trofik ditegakkan berdasarkan gejala klinis berupa beberapa ulkus di telapak kaki disertai anestesi dengan dasar jaringan granulasi, timbul sejak empat tahun yang lalu. Ulkus berbentuk oval dan berukuran 4 cm x 5 cm x 1,5 cm. Pasien diterapi dengan hidrokoloid yang diaplikasikan pada luka dan diganti setiap 3 hari sekali. Perbaikan ulkus trofik pada kasus ini mulai tampak pada hari ke-28 berupa ulkus semakin dangkal dan mengecil. Pada pengamatan hari ke-70, ulkus menutup menjadi sikatriks eutrofik. Berdasarkan laporan kasus ini, penggunaan hidrokoloid merupakan pilihan terapi yang efektif bila digunakan pada jenis luka yang tepat dan dipantau secara rutin.Kata kunci: ulkus trofik, kusta, hidrokoloid

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Leg ulcer in lepromatous leprosy - Case report

Cited by 5 publications

References 6 publications

Unusual non-trophic ulcerations in leprosy: A case series of 17 patients

Unusual non-trophic ulcerations in leprosy: A case series of 17 patients

Ulcers in leprosy patients, an unrecognized clinical manifestation: a report of 8 cases

Modern Wound Dressing Pada Ulkus Trofik Pasien Kusta Tipe Lepromatosa

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