Leprosy in transplant recipients: report of a case after liver transplantation and review of the literature

被引:14
作者
Trindade, M. A. B. [2 ,3 ]
Palermo, M. L. [4 ]
Pagliari, C. [5 ]
Valente, N. [2 ]
Naafs, B. [6 ]
Massarollo, P. C. B. [7 ]
D'Albuquerque, L. A. C. [8 ]
Benard, G. [1 ,4 ]
机构
[1] Univ Sao Paulo, Lab Med Invest, Unit 53, Inst Trop Med, Sao Paulo, Brazil
[2] Univ Sao Paulo, Sch Med, Div Clin Dermatol, Clin Hosp, Sao Paulo, Brazil
[3] Sao Paulo State Hlth Dept, Hlth Inst, Sao Paulo, Brazil
[4] Univ Sao Paulo, Sch Med, Lab Med Invest, Dept Dermatol,Unit 56, Sao Paulo, Brazil
[5] Univ Sao Paulo, Sch Med, Dept Pathol, Sao Paulo, Brazil
[6] Leiden Univ, Med Ctr, Leiden, Netherlands
[7] Irmandade Santa Casa Misericordia Sao Paulo, Liver Transplantat Serv, Sao Paulo, Brazil
[8] Hosp Beneficencia Portuguesa Sao Paulo, Specialized Therapeut Ctr Liver, Sao Paulo, Brazil
关键词
liver transplant; leprosy; immunosuppression; Mycobacterium leprae; RENAL-TRANSPLANTATION; MYCOPHENOLATE-MOFETIL; LEPROMATOUS LEPROSY; TUBERCULOSIS; COINFECTION; MECHANISMS; INFECTION;
D O I
10.1111/j.1399-3062.2010.00549.x
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
P>Leprosy still is an important public health problem in several parts of the world including Brazil. Unlike the diseases caused by other mycobacteria, the incidence and clinical presentation of leprosy seems little affected in immunosuppressed patients. We report the first case, to our knowledge, of a liver transplant patient who developed multi-bacillary leprosy. The patient presented with papules and infiltrated plaques with loss of sensation suggestive of leprosy 3.5 years after living-related liver transplantation for autoimmune hepatitis. A skin biopsy showing non-caseating macrophagic granulomas, neuritis, and intact acid-fast bacilli on Fite-Faraco stain, confirmed the diagnosis of borderline lepromatous leprosy. The donor of the liver did not show any evidence of leprosy. During follow-up, the patient presented 2 episodes of upgrading leprosy type I reactions, 1 mild before leprosy treatment, and 1 moderate 3 months after receiving standard multi-drug treatment (rifampicin, clofazimine, and dapsone). These reactions were accompanied by increase in liver function tests, especially of canalicular enzymes. This reaction occurred despite the patient's triple immunosuppression regimen. The moderate reaction was successfully treated with further immunosuppression (prednisone, 0.5 mg/kg). Currently, the patient is asymptomatic, off leprosy medication, with routine liver transplant follow-up. The dilemmas in diagnosis and management of such a case are discussed and the literature on leprosy in transplant recipients is reviewed.
引用
收藏
页码:63 / 69
页数:7
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