PDF(Pubmed)
Abstract：
UNASSIGNED: The Lucio phenomenon (LP) is a characteristic reaction pattern seen in patients with diffuse lepromatous leprosy (DLL). Dual infection with Mycobacterium leprae and Mycobacterium lepromatosis in DLL has been confirmed from other endemic countries but not previously documented from India. Conventionally, LP is treated with a high dose of systemic glucocorticoid (GC) and anti-leprosy treatment (ALT). Here we report a case of leprosy lymphadenitis at initial presentation in a patient with LP and DLL due to dual infection with M. leprae and M. lepromatosis who responded favourably to tofacitinib as adjuvant to ALT and systemic GC therapy.
UNASSIGNED: A 20- to 30-year-old man presented with swelling over the bilateral inguinal region, pus-filled skin lesions with multiple ulcers, fever and joint pain. Post-hospitalization investigations showed the presence of anaemia, leukocytosis, and elevated acute and chronic inflammatory markers. Skin and lymph node biopsies were suggestive of LP and leprosy lymphadenitis. The presence of M. leprae and M. lepromatosis was confirmed by PCR followed by DNA sequencing of PCR amplicons from tissue. Despite anti-leprosy treatment, oral GC and thalidomide therapy, the patient continued to develop new lesions. One month after the commencement of adjuvant tofacitinib, the patient showed excellent clinical improvement with healing of all existing lesions and cessation of new LP lesions.
UNASSIGNED: Our case confirms the presence of dual infection with M. leprae and lepromatosis in India. Lymph node involvement as an initial presentation of DLL should be considered in endemic areas. Tofacitinib may be a promising new adjuvant therapy for recalcitrant lepra reactions.
UNASSIGNED: A 20- to 30-year-old man presented with swelling over the bilateral inguinal region, pus-filled skin lesions with multiple ulcers, fever and joint pain. Post-hospitalization investigations showed the presence of anaemia, leukocytosis, and elevated acute and chronic inflammatory markers. Skin and lymph node biopsies were suggestive of LP and leprosy lymphadenitis. The presence of M. leprae and M. lepromatosis was confirmed by PCR followed by DNA sequencing of PCR amplicons from tissue. Despite anti-leprosy treatment, oral GC and thalidomide therapy, the patient continued to develop new lesions. One month after the commencement of adjuvant tofacitinib, the patient showed excellent clinical improvement with healing of all existing lesions and cessation of new LP lesions.
UNASSIGNED: Our case confirms the presence of dual infection with M. leprae and lepromatosis in India. Lymph node involvement as an initial presentation of DLL should be considered in endemic areas. Tofacitinib may be a promising new adjuvant therapy for recalcitrant lepra reactions.
摘要：
■Lucio现象（LP）是在弥漫性麻风病（DLL）患者中观察到的一种特征性反应模式。在DLL中，麻风分枝杆菌和麻风分枝杆菌的双重感染已从其他流行国家得到证实，但印度以前没有记录。传统上,用高剂量的全身性糖皮质激素(GC)和抗麻风治疗(ALT)治疗LP。在这里，我们报告了一例由于麻风分枝杆菌和麻风分枝杆菌双重感染而导致的LP和DLL患者最初出现麻风淋巴结炎的病例，该患者对托法替尼作为ALT和全身GC治疗的辅助治疗反应良好。
■一名20至30岁的男子表现为双侧腹股沟区肿胀，充满脓液的皮肤病变伴多发性溃疡，发烧和关节痛。住院后的调查显示有贫血,白细胞增多,以及急性和慢性炎症标志物升高。皮肤和淋巴结活检提示LP和麻风淋巴结炎。通过PCR,随后对来自组织的PCR扩增子进行DNA测序来确认麻风分枝杆菌和麻风分枝杆菌的存在。尽管进行了抗麻风病治疗,口服GC和沙利度胺治疗，患者继续发展新的病变。托法替尼佐剂开始后一个月，患者表现出良好的临床改善，所有现有病变均已愈合，新的LP病变已停止。
■我们的病例证实了印度存在麻风分枝杆菌和麻风病的双重感染。在流行地区应考虑淋巴结参与作为DLL的初始表现。Tofacitinib可能是一种有前途的新辅助治疗顽固性lepra反应。
■一名20至30岁的男子表现为双侧腹股沟区肿胀，充满脓液的皮肤病变伴多发性溃疡，发烧和关节痛。住院后的调查显示有贫血,白细胞增多,以及急性和慢性炎症标志物升高。皮肤和淋巴结活检提示LP和麻风淋巴结炎。通过PCR,随后对来自组织的PCR扩增子进行DNA测序来确认麻风分枝杆菌和麻风分枝杆菌的存在。尽管进行了抗麻风病治疗,口服GC和沙利度胺治疗，患者继续发展新的病变。托法替尼佐剂开始后一个月，患者表现出良好的临床改善，所有现有病变均已愈合，新的LP病变已停止。
■我们的病例证实了印度存在麻风分枝杆菌和麻风病的双重感染。在流行地区应考虑淋巴结参与作为DLL的初始表现。Tofacitinib可能是一种有前途的新辅助治疗顽固性lepra反应。
