TY - JOUR KW - leprosy KW - Multibacillary leprosy (MB) KW - lepromatous leprosy KW - Drug Therapy AU - Rodríguez G AU - Arias V AB -
Patients with lepromatous leprosy (LL) that have received treatment for many years, usually get follow up biopsies for persistent skin lesions or positive bacilloscopy, even with lower values than in the initial bacilloscopy. Here, we report a case of a 48-year old woman with long-standing LL of 15 years of evolution, with a bacterial index (BI) of 4 in the direct smear and in the initial skin biopsy. The patient was treated with multidrug therapy (MDT) for 32 months although the treatment recommended by de World Health Organization (WHO) is only for 12 months. A skin biopsy was taken to determine if there was active disease. A diffuse dermal inflammation with numerous foreign body giant cells and vacuolated macrophages (Virchow ́s cells) was observed. These cells contained granular acid-fast material that was also positive with immunohistochemistry (IHC) for BCG. There were fragmented bacilli and the BI was 2. These cells were also strongly positive for CD68. The biopsy was interpreted as a residual form of LL that did not require further MDT. We have observed similar histological profiles in several cases. Lack of clinical data makes it a histological challenge. Accumulation of lipids in these giant cells is due to bacillary destruction and fusion of vacuolated macrophages. The role of bacillary and host lipids in the pathogenesis of lepromatous leprosy is discussed. There is no need to extend the 12-month MDT recommended by the WHO. Clinical findings, bacilloscopy, annual skin biopsy, and anti-phenolic glycolipid-IIgM titles are recommended procedures for follow-up of these patients.
BT - Biomédica : revista del Instituto Nacional de Salud IS - 4 J2 - Biomedica LA - spa, eng N2 -
Patients with lepromatous leprosy (LL) that have received treatment for many years, usually get follow up biopsies for persistent skin lesions or positive bacilloscopy, even with lower values than in the initial bacilloscopy. Here, we report a case of a 48-year old woman with long-standing LL of 15 years of evolution, with a bacterial index (BI) of 4 in the direct smear and in the initial skin biopsy. The patient was treated with multidrug therapy (MDT) for 32 months although the treatment recommended by de World Health Organization (WHO) is only for 12 months. A skin biopsy was taken to determine if there was active disease. A diffuse dermal inflammation with numerous foreign body giant cells and vacuolated macrophages (Virchow ́s cells) was observed. These cells contained granular acid-fast material that was also positive with immunohistochemistry (IHC) for BCG. There were fragmented bacilli and the BI was 2. These cells were also strongly positive for CD68. The biopsy was interpreted as a residual form of LL that did not require further MDT. We have observed similar histological profiles in several cases. Lack of clinical data makes it a histological challenge. Accumulation of lipids in these giant cells is due to bacillary destruction and fusion of vacuolated macrophages. The role of bacillary and host lipids in the pathogenesis of lepromatous leprosy is discussed. There is no need to extend the 12-month MDT recommended by the WHO. Clinical findings, bacilloscopy, annual skin biopsy, and anti-phenolic glycolipid-IIgM titles are recommended procedures for follow-up of these patients.
PY - 2019 EP - 17 T2 - Biomédica : revista del Instituto Nacional de Salud TI - Giant cells lepromatous leprosy. Diffuse dermatitis with exuberant foreign body giant cells in treated lepromatous leprosy. TT - Células gigantes en lepra lepromatosa. Dermatitis difusa con células gigantes tipo cuerpo extraño exuberantes en lepra lepromatosa tratada UR - https://www.revistabiomedica.org/index.php/biomedica/article/view/4493/4242 VL - 39 ER -