Comprehensive Analysis of the Clinical and Pathological Presentation of Nodular Lepromatous Leprosy: A Prospective and Multidisciplinary Evaluation

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Maria Reyna Lara Guevara
Salmahk Karen Avilés Tenorio
Daniela Denisse Torreros Lara
Magda Azucena Quintana Jacquez
Fernanda Guijosa Ortega

Abstract

Nodular lepromatous leprosy, an atypical and advanced manifestation of lepromatous leprosy, constitutes a significant clinical and diagnostic challenge in the dermatologic disease landscape. In the present study, a comprehensive and multidimensional inquiry of this leprosy variant is undertaken to provide an enriched understanding of its clinical phenotype and underlying pathologic profile.


This article is based on a prospective investigation involving a series of patients with nodular lepromatous leprosy, in which detailed clinical, histopathological and immunohistochemical analyses were performed. Through the integration of clinical findings with microscopic evaluations, the distinctive features of this nodular form are delineated, highlighting its diversified clinical presentation, which may include cutaneous nodules, peripheral nerve involvement and advanced systemic dissemination.


Histopathological analysis highlights the diffuse infiltration of infected Schwann cells in the dermal nodules, as well as Langerhans cell hyperplasia and intense inflammatory response. In addition, immunohistochemical implications are explored, revealing increased expression of inflammatory markers and the involvement of immunomodulatory cells in the pathogenesis of the disease.


Overall, this article seeks to fill the gap in the medical literature regarding nodular lepromatous leprosy by providing a comprehensive and up-to-date assessment of its clinical presentation and pathologic basis. The information derived from this study may not only enrich the current understanding of lepromatous leprosy as a whole, but also guide future research toward more precise and personalized therapeutic approaches for this particular clinical variant.

Article Details

How to Cite
Maria Reyna Lara Guevara, Salmahk Karen Avilés Tenorio, Daniela Denisse Torreros Lara, Magda Azucena Quintana Jacquez, & Fernanda Guijosa Ortega. (2023). Comprehensive Analysis of the Clinical and Pathological Presentation of Nodular Lepromatous Leprosy: A Prospective and Multidisciplinary Evaluation. International Journal of Medical Science and Clinical Research Studies, 3(9), 1862–1866. https://doi.org/10.47191/ijmscrs/v3-i9-12
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Articles

References

I. White C, Franco-Paredes C. Leprosy in the 21st century. Clin Microbiol Rev 2015; 28: 80-94. doi: 10.1128/CMR.00079-13.

II. Franco-Paredes C, Marcos L A, Henao-Martínez A F, Rodríguez-Morales A J, Villamil-Gómez W E, Gotuzzo E, et al. Cutaneous mycobacterial infections. Clin Microbiol Rev 2018; 32: e00069-18. doi: 10.1128/CMR.00069-18.

III. World Health Organization. Leprosy (Hansen's disease). Geneva: WHO; September 10, 2019. Available at:

https://www.who.int/data/gho/data/themes/topics/leprosy-hansens-disease

IV. Ministry of Health of Peru. MINSA: 90% of people exposed to leprosy bacillus do not develop the disease. Lima: MINSA; March 27, 2019. Available at:e/portaldpctb/noticias/detalle_noticia.aspx?not=1097.

V. Ministry of Health. Norma técnica de salud para la prevención, atención integral y control de la lepra en el Perú. NTS N° 149-MINSA 2019 DGIESP/RM N°271-2019 MINSA. Lima: MINSA; March 20, 2019. Available at:

http://www.tuberculosis.minsa.gob.pe/portaldpctb/recursos/20190404120429.PDF

VI. Jiménez-Luna G. Hansen's disease in Peru. Dermatol Peru 2018; 28 (4): 208-19. . Available at: https://www.dermatologiaperuana.pe/assets/uploads/n4_02.pdf

VII. Naaz F, Mohanty P S, Bansal A K, Kumar D, Gupta U D. Challenges beyond elimination in leprosy. Int J Mycobacteriol 2017; 6: 222-8. doi: 10.4103/ijmy.ijmy_70_17. [ Links ]

VIII. Burstein Z. Critical appraisals of leprosy control and elimination programs in Peru and their implications for Peru and the Americas. Rev Peru Med Exp Salud Publica 2014; 31: 336-42.

IX. Moreira Pescarini J, Strina A, Silva Nery J, Menezes Skalinski L, Freitas de Andrade KV, Penna MLF, et al. Socioeconomic risk markers of leprosy in high-burden countries: A systematic review and meta-analysis. PLoS Negl Trop Dis 2018; 12: e0006622. doi: 10.1371/journal.pntd.0006622.

X. Gaschignard J, Grant A V, Thuc N V, Orlova M, Cobat A, Huong N T, et al. Pauci- and multibacillary leprosy: two distinct, genetically neglected diseases. PLoS Negl Trop Dis 2016; 10: e0004345. doi: 10.1371/journal.pntd.0004345.

XI. Sardana K, Khurana A. Leprosy stigma & the relevance of emergent therapeutic options. Indian J Med Res 2020; 151: 1-5. doi: 10.4103/ijmr.IJMR_2625_19.

XII. Chopra A, Mitra D, Agarwal R, Saraswat N, Talukdar K, Solanki A. Correlation of dermoscopic and histopathologic patterns in leprosy - a pilot study. Indian Dermatol Online J 2019; 10: 663-8. doi: 10.4103/idoj.IDOJ_297_18. [ Links ]

XIII. Bhat R M, Vaidya T P. What is new in the pathogenesis and management of erythema nodosum leprosum. Indian Dermatol Online J 2020; 11: 482-92. doi: 10.4103/idoj.IDOJ_561_19.

XIV. Panda P K, Prajapati R, Kumar A, Jana M, Immanuel P, Tanwar P, et al. A case of leprosy, erythema nodosum leprosum, and hemophagocytic syndrome: A continuum of manifestations of same agent-host interactions. Intractable Rare Dis Res 2017; 6: 230-3. doi: 10.5582/irdr.2017.01048.

XV. Schmitz V, dos Santos J B. COVID-19, leprosy, and neutrophils. PLoS Negl Trop Dis 2021; 15 (1): e0009019. doi: 10.1371/journal.pntd.0009019.

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