Wednesday, June 22, 2011

Patient with leprosy awaiting renal transplant in the USA

Leprosy Mailing List – April 9th, 2011
Ref:    Patient with leprosy awaiting renal transplant in the USA
From: Barreto J. A., Bauru, S. Paulo, Brazil

Dear Dr Noto,
Thank you very much to prof. Coster for presenting her case (LML April 6th, 2011).  I had seen cases like this here in Brazil.  This patient probably had a Lucio's fenomenon, or necrotizing erythema nodosum leprosum (ENL) reaction, which was likely the cause of "vasculitis".  It is common that advanced lepromatous leprosy patients have renal complications, for many reasons: glomerulonephritis due to subclinical ENL, cryoglobulinemia, or even by secondary amyloidosis.
Secondary cryoglobulinemia, as well as ANA, rheumatoid factor, VDRL and antiphosfolipid antibodies are common laboratory features, and for this reasons, even in Brazil, lepromatous leprosy patients are usually treated as having "reumathological diseases" for many years before the correct diagnosis is made.  It is also common that upper airways, till the limit of laringeal cartilage, be compromised by leprosy, and in the past, episodes of ENL with upper airway obstruction were quite common.
It would be interesting to perform a biopsy of minor salivary glands and to make a Congo Red staining to assess the diagnosis of amyloidosis.  Nevertheless, I had traveled many times to the Brazilian states of Mato Grosso and Mato Grosso do Sul, which are sited at the right side from Bolivia, and I know that several Bolivians are treated for leprosy in Brazil because they don't have experts in their country, once the disease was considered "eliminated", as well as in some states of Brazil where leprosy is also diagnosed too late.
Jaison A. Barreto
Instituto Lauro de Souza Lima
Bauru, Brazil. 

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