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A Patient with Erythema Nodosus Leprosum and Chagas Cardiopathy: Challenges in Patient Management and Review of the Literature

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  • Division of Clinical Dermatology, and Division of Infectious Diseases, Clinics Hospital, Medical School, University of Sao Paulo, Sao Paulo, Brazil; Health Institute, São Paulo State Health Department, São Paulo, Brazil; Department of Pathology, Medical School, University of Sao Paulo, Sao Paulo, Brazil; Laboratory of Medical Investigation Units 46, 48, and 53, Tropical Medicine Institute, University of São Paulo, São Paulo, Brazil; Laboratory of Medical Investigation Unit 56, Division of Clinical Dermatology, Medical School, University of Sao Paulo, Sao Paulo, Brazil

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.

Author Notes

*Address correspondence to Gil Benard, Laboratory of Medical Investigation, Unit 56, Division of Clinical Dermatology, Medical School, University of Sao Paulo, Brazil and Laboratory of Medical Investigation Unit 53, Tropical Medicine Institute, University of São Paulo, Brazil. E-mail: mahong@usp.brMaria Ângela B. Trindade and Noemia B. Carvalho are first authors and Gil Benard and Maria A. Shikanai-Yasuda are senior authors.

Authors' addresses: Maria Ângela B. Trindade, Division of Clinical Dermatology, Clinics Hospital, Medical School, University of Sao Paulo, Brazil and Health Institute, São Paulo State Health Department, Brazil, E-mail: angelatrindade@uol.com.br. Noemia B. Carvalho, Division of Infectious Diseases, Clinics Hospital, Medical School, University of Sao Paulo, Brazil, E-mail: nobc@uol.com.br. Elaini C. Belfort, Division of Clinical Dermatology, Clinics Hospital, Medical School, University of Sao Paulo, Brazil, E-mail: ecbelfort@uol.com.br. Carla Pagliari, Department of Pathology, Medical School, University of Sao Paulo, Brazil, E-mail: cpagliari@usp.br. Erika Gakiya, Laboratory of Medical Investigation Unit 46, Tropical Medicine Institute, University of São Paulo, Brazil, E-mail: erikagakiya@hotmail.com. Neusa Y. Sakai-Valente, Laboratory of Medical Investigation Unit 53, Tropical Medicine Institute, University of São Paulo, Brazil, E-mail: neusavalente@itelefonica.com.br. Gil Benard, Laboratory of Medical Investigation Unit 56, Division of Clinical Dermatology, Medical School, University of Sao Paulo, Brazil and Laboratory of Medical Investigation Unit 53, Tropical Medicine Institute, University of São Paulo, Brazil, E-mail: mahong@usp.br. Maria A. Shikanai-Yasuda, Laboratory of Medical Investigation Unit 48, Tropical Medicine Institute, University of São Paulo, Brazil, E-mail: shikanaiyasuda@gmail.com.

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