Leprosy Mailing List – November 15, 2017
Ref.: (LML) Dactylitis and Cold Abscess in Leprosy
From: Kalid Al Aboud, Makkah, Saudi Arabia
Dear Dr. Schreuder and colleagues,
Leprosy has a protean clinical feature. I wish to share you the occurrence of dactylitis and Cold abscess in a 48 old Indonesian patient, affected by leprosy, who came to Makkah to perform Hajj (see the attached figure). She presented with generalized erythematous nodules, predominantly affecting the face. Classification BL/LL. She was not known to have leprosy or treated before. On the thenar aspect of the palm we found a fluctuating abscess-like swelling, but without tenderness or heat.
I feel these 2 clinical signs are not commonly recognized and I found few reports about these features in Pubmed (see references below)
Dactylitis or sausage digit is inflammation of an entire digit (a finger or toe), and can be painful. The word dactyl comes from the Greek word "daktylos" meaning "finger". In its medical term, it refers to both the fingers and the toes.
Dactylitis can occur in seronegative arthropathies such as psoriatic arthritis, ankylosing spondylitis and sickle cell disease as result of a vaso-occlusive crisis with bone infarcts, and in infectious conditions including tuberculosis and leprosy. In reactive arthritis, sausage fingers occur due to synovitis. In sickle-cell disease it manifests itself for the first time in 6-9 month old infants (as their protective foetal haemoglobin, HbF, is replaced with adult haemoglobin and the disease manifests) and is very often the presenting sign of the disorder.
Cold abscess refers to an abscess that lacks the intense inflammation usually associated with infection. This may be associated with infections due to bacteria like tuberculosis and fungi like blastomycosis that do not tend to stimulate acute inflammation. Alternatively, cold abscesses are typical in persons with hyperimmunoglobulin E syndrome, even when infected with an organism like Staph aureus which causes typical ("hot") abscesses in others. Signs of acute inflammation are absent, so the abscess is not hot and red as in a typical abscess filled with pus. Cold abscesses are generally painless cysts that may be subcutaneous, ocular, or in deep tissue such as the spine.
1.Multifocal scrofuloderma overlying tuberculous dactylitis in an immunocompetent child.
Bhat YJ, et al. Indian J Dermatol Venereol Leprol. 2015 Jul-Aug.
2.Borderline Hansen complicated by a metastatic cold abscess.
Sethi S, et al. Lepr Rev. 2015.
3.Multiple cold abscesses in a borderline lepromatous patient on multidrug therapy.
Kulkarni V, et al. Indian J Lepr. 1989.
4.Dactylitis.A page on Wikipedia ; available at https://en.m.wikipedia.org/wiki/Dactylitis
5.Cold abscess.A page on Wikipedia ;available at
Dr Khalid Al Aboud
Head of Public Health Dept.
King Faisal Hospital
LML - S Deepak, B Naafs, S Noto and P Schreuder
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