Skip to main content
main-content

01.12.2017 | Case report | Ausgabe 1/2017 Open Access

BMC Dermatology 1/2017

A case report of erythroderma in a patient with borderline leprosy on reversal reaction: a result of the exacerbated reaction?

Zeitschrift:
BMC Dermatology > Ausgabe 1/2017
Autoren:
Denis Miyashiro, Ana Paula Vieira, Maria Angela Bianconcini Trindade, João Avancini, José Antonio Sanches, Gil Benard
Wichtige Hinweise

Electronic supplementary material

The online version of this article (10.​1186/​s12895-017-0068-3) contains supplementary material, which is available to authorized users.

Abstract

Background

Erythroderma is characterized by erythema and scaling affecting more than 90% of the body surface area. Inflammatory, neoplastic and, more rarely, infectious diseases may culminate with erythroderma. Diagnosis of the underlying disorder is therefore crucial to institute the appropriate therapy. Leprosy is a chronic infectious disease that is endemic in Brazil. Here we present an unusual case of leprosy and reversal reaction causing erythroderma, and we discuss the underlying immunological mechanisms which could contribute to the generalized skin inflammation.

Case presentation

We report a case of a patient with reversal reaction (RR) in borderline borderline leprosy presenting with erythroderma and neural disabilities. Histopathology of the skin showed regular acanthosis and spongiosis in the epidermis and, in the dermis, compact epithelioid granulomas as well as grouped and isolated bacilli. This duality probably reflects the transition from an anergic/multibacillary state to a state of more effective immunity and bacillary control, typical of RR. Leprosy was successfully treated with WHO’s multidrug therapy, plus prednisone for controlling the RR; the erythroderma resolved in parallel with this treatment. Immunologic studies showed in situ predominance of IFNγ + over IL-4+ lymphocytes and of IL-17+ over Foxp3+ lymphocytes, suggesting an exacerbated Th-1/Th-17 immunoreactivity and poor Th-2 and regulatory T-cell responses. Circulating Tregs were also diminished. We hypothesize that the flare-up of anti-mycobacteria immunoreactivity that underlies RR may have triggered the intense inflammatory skin lesions that culminated with erythroderma.

Conclusions

This case report highlights the importance of thorough clinical examination of erythrodermic patients in search for its etiology and suggests that an intense and probably uncontrolled leprosy RR can culminate in the development of erythroderma.
Zusatzmaterial
Literatur
Über diesen Artikel

Weitere Artikel der Ausgabe 1/2017

BMC Dermatology 1/2017 Zur Ausgabe

Neu im Fachgebiet Dermatologie

Meistgelesene Bücher aus dem Fachgebiet

2015 | Buch

Selbstzahlerleistungen in der Dermatologie und der ästhetischen Medizin

Dieses Buch beschreibt über 50 sinnvolle Selbstzahlerleistungen der dermatologisch-ästhetischen Diagnostik und Therapie. Lernen Sie, wie Sie Ihr Praxisangebot mit bewährten und innovativen Methoden erfolgreich ausbauen, Ihre Umsätze steigern und die Wünsche Ihrer Patienten erfüllen.

Herausgeber:
Bernd Kardorff

2012 | Buch

Häufige Hauttumoren in der Praxis

Warzen, Nävi, Zysten, aktinische Keratosen, malignes Melanom – im ärztlichen Alltag begegnet man einer Vielzahl von Hauttumoren oder tumorartigen Hautveränderungen. Dieses Buch bietet übersichtliche Tabellen zur Schnellorientierung, prägnante Darstellung des klinischen Bildes und Tipps zur angemessenen Therapie.

Autoren:
Prof. Dr. med. habil. Sabine G. Plötz, Prof. Dr. med. Rüdiger Hein, Prof. Dr. med. Dr. phil. Johannes Ring

Mail Icon II Newsletter

Bestellen Sie unseren kostenlosen Newsletter Update Dermatologie und bleiben Sie gut informiert – ganz bequem per eMail.

Bildnachweise