Virchowian leprosy and erythema nodosum leprosum in a 34-week pregnant woman without any previous diagnosis
DOI:
https://doi.org/10.11606/issn.1679-9836.v101i1e-170709Keywords:
Leprosy, Neglected tropical diseases, Virchowian leprosy, Erythema nodosum leprosum, Infectious complications of pregnancyAbstract
We report a case of a pregnant female patient in the third trimester undergoing regular prenatal care at a Basic Health Unit, with good gestational evolution, but presenting skin lesions for approximately a year accompanied by changes in sensitivity, in addition to facial infiltration and madarosis. Considering Brazil as an endemic country for leprosy, ranking 2nd in the world concerning the number of new cases, late diagnosis of the patient in question stands out. We use this emblematic case report to discuss important aspects concerning the treatment of leprosy during the gestational period (multidrug therapy according to the Ministry of Health manual, without any changes due to pregnancy), obstetric outcome, guidelines regarding breastfeeding (not contraindicated with the mother in treatment; on the contrary, it should be stimulated) and care for the newborn.
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References
Estratégia mundial para hanseníase 2016-2020: aceleração rumo a um mundo sem hanseníase. Guia para monitorização e avaliação. Nova Deli: Organização Mundial da Saúde, Escritório Regional para o Sudoeste Asiático; 2017. Disponível em: https://apps.who.int/iris/bitstream/handle/10665/254907/9789290225881-por.pdf?sequence=8.
Brasil. Ministério da Saúde. Guia prático sobre a hanseníase. Guia prático sobre a hanseníase. Brasília: Ministério da Saúde; 2017. Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/guia_pratico_ hanseniase.%0Apdf.
Singh P, Benjak A, Schuenemann VJ, Herbig A, Avanzi C, Busso P, et al. Insight into the evolution and origin of leprosy bacilli from the genome sequence of Mycobacterium lepromatosis. Proc Natl Acad Sci U S A. 2015;112:4459–64. doi: 10.1073/pnas.1421504112.
World Health Organization. Global leprosy update, 2018: moving towards a leprosy free world. Wkly Epidemiol Rec. 2019;35/36:389-412. Available from: https://apps.who.int/iris/bitstream/handle/10665/326775/WER9435-36-en-fr.pdf.
World Health Organization. Guidelines for the diagnosis, treatment and prevention of leprosy. Nova Deli: WHO; 2018. Available from: https://apps.who.int/iris/bitstream/handle/10665/274127/9789290226383-eng.pdf?ua=1.
Mi Z, Liu H, Zhang F. Advances in the immunology and genetics of leprosy. Front Immunol. 2020;11:567. doi: 10.3389/fimmu.2020.00567.
Brasil. Ministério da Saúde. Diretrizes para vigilância, atenção e eliminação da Hanseníase como problema de saúde pública. Brasília: Ministério da Saúde; 2016. Disponível em: https://pt.scribd.com/document/323388710/Diretrizes-para-vigilancia-atencao-e-eliminacao-da-hanseniase-como-problema-de-saude-publica-2016.
Ozturk Z, Tatliparmak A. Leprosy treatment during pregnancy and breastfeeding: a case report and brief review of literature. Dermatol Ther. 2017;30:1-2. doi: 10.1111/dth.12414.
Nogueira PSF, Moura ERF, Dias AA, Américo CF, Aguiar LR, Valente MMQP. Characteristics of pregnant and lactating women with leprosy. Rev Soc Bras Med Trop. 2015;48:96–8. doi: 10.1590/0037-8682-0148-2014.
Duncan E. Leprosy in pregnancy. In: Leprosy: a pratical guide. Milan: Springer; 2012. p.331-40. Available from: http://link.springer.com/10.1007/978-88-470-2376-5.
Costa PSS, Fraga LR, Kowalski TW, Daxbacher ELR, Schuler-Faccini L, Vianna FSL. Erythema nodosum leprosum: update and challenges on the treatment of a neglected condition. Acta Trop. 2018;183:134-41. doi: 10.1016/j.actatropica.2018.02.026.
Oliveira SG, Tavares CM, Moura ERF, Trindade RFC, Almeida AM, Bomfim EO. Gestação e hanseníase : uma associação de risco nos serviços de saúde. Hansen Int. 2011;36(1):31-8. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/guia_de_hanseniase.pdf
Upputuri B, Pallapati MS, Tarwater P, Srikantam A. Thalidomide in the treatment of erythema nodosum leprosum (ENL) in an outpatient setting: a five-year retrospective analysis from a leprosy referral centre in India. PLoS Negl Trop Dis. 2020;14(10):e0008678. doi: 10.1371/journal.pntd.0008678.
Chen Z, Kuang Y, Jiang H, Zhang W, Shi Y, Chokkakula S, et al. Intact Mycobacterium leprae Isolated from Placenta of a Pregnant Woman, China. Emerg Infect Dis. 2019;25(8):1604-7. doi: 10.3201/eid2508.190114 15.
Lamounier JA, Moulin ZS, Xavier CC. Recommendations for breastfeeding during maternal infections. J Pediatr (Rio J). 2004;80(5 Suppl):S181–8. doi: 10.2223/1252.
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Copyright (c) 2022 Gustavo Moreira Amorim, Thaynara Maestri, Amanda Oppitz, Matheus Leye, Filipe Luis Merini, Luan Junior Vignatti
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