(LML) Dactylitis and Cold Abscess in Leprosy

Leprosy Mailing List – November 17,  2017

Ref.:    (LML) Dactylitis and Cold Abscess in Leprosy

From:  Wim Theuvenet, Annick Mondjo and  Khalid Al Aboud

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Question Wim Theuvenet:

 

Thank Dr. Khalid for sharing this case (LML, November 15, 2017. As dig. I and V are both involved I personally wonder whether there is not a "horse shoe" abscess with a communicating flexor tendon sheath infection=pannaritium, which communicates with each other at wrist level? Indication for ultrasound examination and a consultation of a Hand Surgeon for exploration/ histology/ cultures incl. mycobacteria?

 

The underlaying cause may be any sort of infection. Have once seen this in T.B! Please keep us informed on the outcome!

 

Best regards,

 

Willem J.Theuvenet, M.D, Ph.D

Plast. Rec. Hand Surgeon and Leprologist

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Question Annick Mondjo:

 

I would like to ask Dr. Khalid the following questions:

-       What is the aspect of pathological examination? and

-       What about the evolution of these disseminated painful nodules?

 

For me this case is primarily clinically leprosy evoke/revealed by an ENL.

Dr Annick Mondjo

Directeur du Programme de Lutte contre les Maladies Infectieuses

Ministère de la Santé

BP 50 Libreville

GABON

 

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Reaction Khalid Al Aboud:

 

 

Dear Pieter and colleagues,

 

Many thanks for the comments of Dr. Theuvenet and Dr Annick. The patient was a visitor on Haj for a short period; and we could not investigate her thoroughly. After she went back to her home country we did not hear from her anymore. We are also not aware if she continued her treatment after leaving from here.

 

She had indolent multiple nodules on the body and predominantly on the face, and was not diagnosed before. ENL is a valid point but a patient with ENL usually has systemic symptoms like pain or fever and usually precipitated by treatment.

Therefore, I thought ENL is unlikely in this case.

 

With my thanks and regards,

 

Khalid 

 

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LML - S Deepak, B Naafs, S Noto and P Schreuder

LML blog link: http://leprosymailinglist.blogspot.it/

Contact: Dr Pieter Schreuder << editorlml@gmail.com