1921
Volume 84, Issue 6
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

We report a patient with severe multi-bacillary leprosy complicated by recurrent episodes of erythema nodosum necrotisans that required thalidomide and/or corticosteroids during follow-up. Although the patient was from an area to which Chagas disease is endemic, this diagnosis was initially missed and was only investigated when heart failure developed in the patient. The difficulties of managing erythema nodosum necrotisans and heart failure concomitantly and those involved in excluding the diagnosis of acute myocarditis caused by reactivation of Chagas disease secondary to the immunosuppressive regimen are discussed. Other potential causes for the heart failure and possible interactions between the two diseases and their treatments are discussed. We also reviewed the literature for the association between leprosy and Chagas disease, both of which are highly endemic in Brazil. This case emphasizes the importance of searching for subclinical co-infections in leprosy patients because reactions frequently develop during specific treatment in these patients, and these reactions require prolonged therapy with immunosuppressive drugs.

Loading

Article metrics loading...

/content/journals/10.4269/ajtmh.2011.10-0547
2011-06-01
2017-11-22
Loading full text...

Full text loading...

/deliver/fulltext/14761645/84/6/973.html?itemId=/content/journals/10.4269/ajtmh.2011.10-0547&mimeType=html&fmt=ahah

References

  1. Global leprosy situation, World Health Organization, 2010. Wkly Epidemiol Rec 33: 333340.
  2. Bolletin de la Organizacion Panamericana de la Salud, 2006. Estimacion Cuantitativa de la Enfermedad de Chagas en las Americas. Montevideo, Uruguay: OPAS.
  3. Portal de Saúde. Available at: http://portal.saude.gov.br/portal/saude/profissional/area.cfm?id_area=1466. Accessed September 29, 2010.
  4. Ridley DS, Jopling WH, , 1966. Classification of leprosy according to immunity: a five-group system. Int J Lepr 34: 255273.
  5. Naafs B, Wheate HW, , 1978. The time interval between the start of anti-leprosy treatment and the development of reactions in borderline patients. Lepr Rev 49: 153157.
  6. Kahawita IP, Lockwood DN, , 2008. Towards understanding the pathology of erythema nodosum leprosum. Trans R Soc Trop Med Hyg 102: 329337.[Crossref]
  7. Higuchi ML, Benvenuti LA, Reis MM, Metzger M, , 2003. Pathophisiology of the heart in Chagas'disease: current status and new developments. Cardiovasc Res 60: 96107.[Crossref]
  8. Bilate AMB, Cunha-Neto E, , 2008. Chagas disease cardiomyopathy: current concepts of an old disease. Rev Inst Med Trop Sao Paulo 50: 6774.[Crossref]
  9. Hotez PJ, Pecoul B, , 2010. “Manifesto” for advancing the control and elimination of neglected tropical diseases. PLoS Negl Trop Dis 4: e718.[Crossref]
  10. Diniz O, , 1948. Lepra e doença de Chagas. Arq Min Leprol 8: 155169.
  11. Dias JCP, Cunha DA, , 1970. Hanseníase e doença de Chagas. Estudos realizados no Sanatório São Francisco de Assis, em Babuí, Minas Gerais. Rev Soc Bras Med Trop 4: 3143.[Crossref]
  12. Bottasso OA, Morini JC, , 1993. Electrocardiographic alterations in lepromatous leprosy patients with concomitant Trypanosoma cruzi infection. Int J Lepr 61: 468471.
  13. Mathur SN, Itigi A, Krishnaveni A, Rao PD, , 1976. Congestive heart failure in two patients with lepromatous leprosy. Lepr India 48: 7580.
  14. Lima MA, Rodrigues-Jr V, Silva-Vergara ML, Nomelini MB, Paim N, Santos TA, Santos VM, , 1998. Hanseníase virchowiana em cardiopata chagásico: relato de necropsia. Relato de caso. Rev Soc Bras Med Trop 31: 385390.[Crossref]
  15. Sartori AM, Ibrahim KY, Nunes Westphalen EV, Braz LM, Oliveira OC, Jr Gakiya E, Lopes MH, Shikanai-Yasuda MA, , 2007. Manifestations of Chagas disease (American trypanosomiasis) in patients with HIV/AIDS. Trop Med Parasitol 101: 3150.[Crossref]
  16. Dagur PK, Sharma B, Kumar G, Khan G, Khan NA, Katoch VM, Senguypta U, Joshi B, , 2010. Mycobacterial antigen(s) induce anergy by altering TCR- and TCR/CD28- induced signaling events: insights into T-cell unresponsiveneness in leprosy. Mol Immunol 42: 941952.
  17. Campos SV, Strabelli TM, Amato Neto V, Silva CP, Bacal F, Bocchi EA, Stolf NA, , 2008. Risk factors for Chagas'disease reactivation after heart transplantation. J Heart Lung Transplant 27: 597602.[Crossref]
  18. Riarte A, Luna C, Sabatiello R, Sinagra A, Shiavelli R, De Rissio A, Maiolo E, Garcia MM, Jacob N, Pattin M, Lauricella M, Segura EL, Vasquez M, , 1999. Chagas' disease in patients with kidney transplants: 7 years of experience, 1989–1996. Clin Infect Dis 29: 561567.[Crossref]
  19. d'Avila SC, d'Avila AM, Pagliari C, Gonçalves VM, Duarte MI, , 2005. Eritema nodoso como forma de reativação da doença de Chagas em transplantado cardíaco. Rev Soc Bras Med Trop 38: 6163.[Crossref]
  20. Brazilian consensus on Chagas' disease diagnosis, 2005. Rev Soc Bras Med Trop 38 (Supplement III): 129.
  21. Gomes ML, Galvão LM, Macedo AM, Pena SD, Chiari E, , 1999. Chagas' disease diagnosis: comparative analysis of parasitologic, molecular, and serologic methods. Am J Trop Med Hyg 60: 205210.
  22. Junqueira AC, Chiari E, Wincker P, , 1996. Comparison of the polymerase chain reaction with two classical parasitological methods for the diagnosis of Chagas disease in an endemic region of north-eastern Brazil. Trans R Soc Trop Med Hyg 90: 129132.[Crossref]
  23. Avila HA, Sigman DS, Cohen LM, Millikan RC, Simpson L, , 1991. Polymerase chain reaction amplification of Trypanosoma cruzi kinetoplast minicircle DNA isolated from whole blood lysates: diagnosis of chronic Chagas' disease. Mol Biochem Parasitol 48: 211222.[Crossref]
  24. Portela-Lindoso AB, Shikanai-Yasuda MA, , 2003. Chronic Chagas' disease: from xenodiagnosis and hemoculture to polymerase chain reaction. Rev Saúde Pública 37: 107115.[Crossref]
  25. Roy SG, De P, Mukherjje D, Chander V, Konar A, Bandyopadhyay D, Babdyopadhyay A, , 2009. Excess of glucocorticoid reduces cardiac dysfunction via activating angiotensin II pathway. Cell Physiol Biochem 24: 110.[Crossref]
  26. Rassi A, Jr Rassi A, Marin-Neto JA, , 2010. Chagas disease. Lancet 375: 13881402.[Crossref]
  27. Korhonen R, Lahti A, Hämäläinen M, Kankaanranta H, Moilanen E, , 2002. Dexamethasone inhibits inducible nitric-oxide synthase expression and nitric oxide production by destabilizing mRNA in lipopolysaccharide-treated macrophages. Mol Pharmacol 62: 698704.[Crossref]
  28. Elenkov IJ, , 2004. Glucocorticoids and the Th1/Th2 balance. Ann N Y Acad Sci 1024: 138146.[Crossref]
  29. Rassi A, Amato Neto V, de Siqueira AF, Doles J, Leite MS, Silva OQ, Cardoso VM, , 1997. Influência de corticóide, na doença de Chagas crônica, administrado em virtude de afecções associadas. Rev Soc Bras Med Trop 30: 9399.[Crossref]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.2011.10-0547
Loading
/content/journals/10.4269/ajtmh.2011.10-0547
Loading

Data & Media loading...

  • Received : 01 Oct 2010
  • Accepted : 27 Feb 2011

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error