Borderline Tuberculoid Leprosy Masquerading as Granuloma Annulare: A Clinical and Histological Pitfall

Zhu, Tian Hao; Kamangar, Faranak; Silverstein, Marc D.; Fung, Maxwell A.

doi:10.1097/dad.0000000000000698

Cited by 10 publications

(10 citation statements)

References 15 publications

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“…Leprosy is an intriguing immunologic complex disease in which M. leprae causes granulomatous lesions and demyelination in the peripheral nerves [ 23 , 24 ]. Leprosy is considered a spectral disease, with clinical and histopathological changes showing strong relationships with the pattern of the immune response triggered in the host [ 6 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Immunohistochemical characterization of the M4 macrophage population in leprosy skin lesions

et al. 2018

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BackgroundSince macrophages are one of the major cell types involved in the Mycobacterium leprae immune response, roles of the M1 and M2 macrophage subpopulations have been well defined. However, the role of M4 macrophages in leprosy or other infectious diseases caused by mycobacteria has not yet been clearly characterized. This study aimed to investigate the presence and potential role of M4 macrophages in the immunopathology of leprosy.MethodsWe analyzed the presence of M4 macrophage markers (CD68, MRP8, MMP7, IL-6, and TNF-α) in 33 leprosy skin lesion samples from 18 patients with tuberculoid leprosy and 15 with lepromatous leprosy by immunohistochemistry.ResultsThe M4 phenotype was more strongly expressed in patients with the lepromatous form of the disease, indicating that this subpopulation is less effective in the elimination of the bacillus and consequently is associated with the evolution to one of the multibacillary clinical forms of infection.ConclusionM4 macrophages are one of the cell types involved in the microbial response to M. leprae and probably are less effective in controlling bacillus replication, contributing to the evolution to the lepromatous form of the disease.

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Section: Discussionmentioning

confidence: 99%

Immunohistochemical characterization of the M4 macrophage population in leprosy skin lesions

et al. 2018

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“…Leprosy also can be characterized by fever and arthritis simulating lupus erythematosus, rheumatoid arthritis, or antiphospholipid syndrome because autoantibodies occur in type II reaction known as erythema nodosum leprosum. Physicians should order a Fite stain on the skin biopsy specimen because Mycobacterium leprae is sensitive to the alcohol decolorizing step; if only a routine acid-fast stain (Ziehl-Neelsen) is ordered, the diagnosis is often missed ( 10 ).…”

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Autochthonous Leprosy without Armadillo Exposure, Eastern United States

Rendini¹,

Levis²

2017

Emerg. Infect. Dis.

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“…ODD) with alpha set at 0.03 to replicate the standardized effect size (log2FC/SD) estimated from RNA sequencing. reinforcing the difficulty in clinically discriminating between these two conditions, and underlining the relevance of their inclusion in our comparisons [29][30][31].…”

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confidence: 56%

A new paradigm for leprosy diagnosis based on host gene expression Insights from leprosy lesions transcriptomics

Leal-Calvo

Avanzi

Mendes

et al. 2021

Preprint

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Transcriptional profiling is a powerful tool to investigate and detect human diseases. In this study, we used bulk RNA-sequencing (RNA-Seq) to compare the transcriptomes in skin lesions of leprosy patients or matched controls affected by other dermal conditions such as granuloma annulare, a confounder for paucibacillary leprosy. We identified five genes capable of accurately distinguishing multibacillary and paucibacillary leprosy from other skin conditions. Indoleamine 2,3-dioxygenase 1 ( IDO1 ) expression alone was highly discriminatory, followed by TLR10, BLK, CD38, and SLAMF7, whereas the HS3ST2 and CD40LG mRNA separated multi- and paucibacillary leprosy. Finally, from the main differentially expressed genes (DEG) and enriched pathways, we conclude that paucibacillary disease is characterized by epithelioid transformation and granuloma formation, with an exacerbated cellular immune response, while multibacillary leprosy features epithelial-mesenchymal transition with phagocytic and lipid biogenesis patterns in the skin. These findings will help catalyze the development of better diagnostic tools and potential host-based therapeutic interventions. Finally, our data may help elucidate host-pathogen interplay driving disease clinical manifestations.

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Borderline Tuberculoid Leprosy Masquerading as Granuloma Annulare: A Clinical and Histological Pitfall

Abstract: This is the first reported case of leprosy masquerading both clinically and histologically as GA. Dermatopathologists should be aware of the possibility of leprosy given the presence of perineural lymphocytes amidst any pattern of granulomatous infiltrate and obtain a Fite stain.

Cited by 10 publications

References 15 publications

Immunohistochemical characterization of the M4 macrophage population in leprosy skin lesions

Immunohistochemical characterization of the M4 macrophage population in leprosy skin lesions

Autochthonous Leprosy without Armadillo Exposure, Eastern United States

A new paradigm for leprosy diagnosis based on host gene expression Insights from leprosy lesions transcriptomics

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