Leprosy in transplant recipients: report of a case after liver transplantation and review of the literature
M.A.B. Trindade, M. de Lourdes Palermo, C. Pagliari, N. Valente, B. Naafs, P.C.B. Massarollo, L.A.C. D'Albuquerque, G. Benard. Leprosy in transplant recipients: report of a case after liver transplantation and review of the literature. Transpl Infect Dis 2011: 13: 63–69. All rights reserved : L...
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| creator | Trindade, M.A.B. Palermo, M.L. Pagliari, C. Valente, N. Naafs, B. Massarollo, P.C.B. D'Albuquerque, L.A.C. Benard, G. |
| description | M.A.B. Trindade, M. de Lourdes Palermo, C. Pagliari, N. Valente, B. Naafs, P.C.B. Massarollo, L.A.C. D'Albuquerque, G. Benard. Leprosy in transplant recipients: report of a case after liver transplantation and review of the literature.
Transpl Infect Dis 2011: 13: 63–69. All rights reserved
: 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. |
| doi_str_mv | 10.1111/j.1399-3062.2010.00549.x |
| format | Article |
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Transpl Infect Dis 2011: 13: 63–69. All rights reserved
: 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.</description><identifier>ISSN: 1398-2273</identifier><identifier>EISSN: 1399-3062</identifier><identifier>DOI: 10.1111/j.1399-3062.2010.00549.x</identifier><identifier>PMID: 20678090</identifier><language>eng</language><publisher>Malden, USA: Blackwell Publishing Inc</publisher><subject>Bacilli ; Biopsy ; Case reports ; clofazimine ; Clofazimine - therapeutic use ; dapsone ; Donors ; Drug Therapy, Combination ; Enzymes ; Glucocorticoids - therapeutic use ; Granuloma ; Hepatitis ; Humans ; Immunosuppression ; Leprostatic Agents - therapeutic use ; Leprosy ; Leprosy, Multibacillary - diagnosis ; Leprosy, Multibacillary - drug therapy ; Leprosy, Multibacillary - microbiology ; Leprosy, Multibacillary - pathology ; liver transplant ; Liver transplantation ; Liver Transplantation - adverse effects ; Male ; Middle Aged ; Mycobacterium leprae ; Mycobacterium leprae - drug effects ; Mycobacterium leprae - isolation & purification ; Neuritis ; Plaques ; Prednisone ; Prednisone - therapeutic use ; Public health ; Rifampin ; Skin ; Skin - microbiology ; Skin - pathology ; Stains ; Treatment Outcome</subject><ispartof>Transplant infectious disease, 2011-02, Vol.13 (1), p.63-69</ispartof><rights>2010 John Wiley & Sons A/S</rights><rights>2010 John Wiley & Sons A/S.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3999-ada049cb2ecc39e6759bda595f1deb8c3e4f9c077e8f228b0c2ed50fe41eee5c3</citedby><cites>FETCH-LOGICAL-c3999-ada049cb2ecc39e6759bda595f1deb8c3e4f9c077e8f228b0c2ed50fe41eee5c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1399-3062.2010.00549.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1399-3062.2010.00549.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20678090$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Trindade, M.A.B.</creatorcontrib><creatorcontrib>Palermo, M.L.</creatorcontrib><creatorcontrib>Pagliari, C.</creatorcontrib><creatorcontrib>Valente, N.</creatorcontrib><creatorcontrib>Naafs, B.</creatorcontrib><creatorcontrib>Massarollo, P.C.B.</creatorcontrib><creatorcontrib>D'Albuquerque, L.A.C.</creatorcontrib><creatorcontrib>Benard, G.</creatorcontrib><title>Leprosy in transplant recipients: report of a case after liver transplantation and review of the literature</title><title>Transplant infectious disease</title><addtitle>Transpl Infect Dis</addtitle><description>M.A.B. Trindade, M. de Lourdes Palermo, C. Pagliari, N. Valente, B. Naafs, P.C.B. Massarollo, L.A.C. D'Albuquerque, G. Benard. Leprosy in transplant recipients: report of a case after liver transplantation and review of the literature.
Transpl Infect Dis 2011: 13: 63–69. All rights reserved
: 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.</description><subject>Bacilli</subject><subject>Biopsy</subject><subject>Case reports</subject><subject>clofazimine</subject><subject>Clofazimine - therapeutic use</subject><subject>dapsone</subject><subject>Donors</subject><subject>Drug Therapy, Combination</subject><subject>Enzymes</subject><subject>Glucocorticoids - therapeutic use</subject><subject>Granuloma</subject><subject>Hepatitis</subject><subject>Humans</subject><subject>Immunosuppression</subject><subject>Leprostatic Agents - therapeutic use</subject><subject>Leprosy</subject><subject>Leprosy, Multibacillary - diagnosis</subject><subject>Leprosy, Multibacillary - drug therapy</subject><subject>Leprosy, Multibacillary - microbiology</subject><subject>Leprosy, Multibacillary - pathology</subject><subject>liver transplant</subject><subject>Liver transplantation</subject><subject>Liver Transplantation - adverse effects</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Mycobacterium leprae</subject><subject>Mycobacterium leprae - drug effects</subject><subject>Mycobacterium leprae - isolation & purification</subject><subject>Neuritis</subject><subject>Plaques</subject><subject>Prednisone</subject><subject>Prednisone - therapeutic use</subject><subject>Public health</subject><subject>Rifampin</subject><subject>Skin</subject><subject>Skin - microbiology</subject><subject>Skin - pathology</subject><subject>Stains</subject><subject>Treatment Outcome</subject><issn>1398-2273</issn><issn>1399-3062</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkU1PxCAQhonR-P0XDDdPXQf6BcaL8TvZxMt6JpROI2u3rcCq---l7qpH5QCT4XmHYV5CKIMJi-tsPmGplEkKBZ9wiFmAPJOTjy2y_3Ox_RWLhPMy3SMH3s8BWCkzuUv2OBSlAAn75GWKg-v9itqOBqc7P7S6C9ShsYPFLvjzGA-9C7RvqKZGe6S6Cehoa9_i_qvRwfYd1V0dBW8W30dBeMbIRVqHpcMjstPo1uPx5jwkT7c3s6v7ZPp493B1OU1M7F0mutaQSVNxNDGBRZnLqta5zBtWYyVMilkjDZQlioZzUYHhWOfQYMYQMTfpITld140_e12iD2phvcE2don90isJJcsFg-JPUuRFBmkpWCTFmjRxWt5howZnF9qtFAM1eqLmahy9GkevRk_UlyfqI0pPNo8sqwXWP8JvEyJwsQbebYurfxdWs4frGKSfTYGdAQ</recordid><startdate>201102</startdate><enddate>201102</enddate><creator>Trindade, M.A.B.</creator><creator>Palermo, M.L.</creator><creator>Pagliari, C.</creator><creator>Valente, N.</creator><creator>Naafs, B.</creator><creator>Massarollo, P.C.B.</creator><creator>D'Albuquerque, L.A.C.</creator><creator>Benard, G.</creator><general>Blackwell Publishing Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7QL</scope><scope>C1K</scope></search><sort><creationdate>201102</creationdate><title>Leprosy in transplant recipients: report of a case after liver transplantation and review of the literature</title><author>Trindade, M.A.B. ; Palermo, M.L. ; Pagliari, C. ; Valente, N. ; Naafs, B. ; Massarollo, P.C.B. ; D'Albuquerque, L.A.C. ; Benard, G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3999-ada049cb2ecc39e6759bda595f1deb8c3e4f9c077e8f228b0c2ed50fe41eee5c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Bacilli</topic><topic>Biopsy</topic><topic>Case reports</topic><topic>clofazimine</topic><topic>Clofazimine - therapeutic use</topic><topic>dapsone</topic><topic>Donors</topic><topic>Drug Therapy, Combination</topic><topic>Enzymes</topic><topic>Glucocorticoids - therapeutic use</topic><topic>Granuloma</topic><topic>Hepatitis</topic><topic>Humans</topic><topic>Immunosuppression</topic><topic>Leprostatic Agents - therapeutic use</topic><topic>Leprosy</topic><topic>Leprosy, Multibacillary - diagnosis</topic><topic>Leprosy, Multibacillary - drug therapy</topic><topic>Leprosy, Multibacillary - microbiology</topic><topic>Leprosy, Multibacillary - pathology</topic><topic>liver transplant</topic><topic>Liver transplantation</topic><topic>Liver Transplantation - adverse effects</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Mycobacterium leprae</topic><topic>Mycobacterium leprae - drug effects</topic><topic>Mycobacterium leprae - isolation & purification</topic><topic>Neuritis</topic><topic>Plaques</topic><topic>Prednisone</topic><topic>Prednisone - therapeutic use</topic><topic>Public health</topic><topic>Rifampin</topic><topic>Skin</topic><topic>Skin - microbiology</topic><topic>Skin - pathology</topic><topic>Stains</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Trindade, M.A.B.</creatorcontrib><creatorcontrib>Palermo, M.L.</creatorcontrib><creatorcontrib>Pagliari, C.</creatorcontrib><creatorcontrib>Valente, N.</creatorcontrib><creatorcontrib>Naafs, B.</creatorcontrib><creatorcontrib>Massarollo, P.C.B.</creatorcontrib><creatorcontrib>D'Albuquerque, L.A.C.</creatorcontrib><creatorcontrib>Benard, G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>Transplant infectious disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Trindade, M.A.B.</au><au>Palermo, M.L.</au><au>Pagliari, C.</au><au>Valente, N.</au><au>Naafs, B.</au><au>Massarollo, P.C.B.</au><au>D'Albuquerque, L.A.C.</au><au>Benard, G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Leprosy in transplant recipients: report of a case after liver transplantation and review of the literature</atitle><jtitle>Transplant infectious disease</jtitle><addtitle>Transpl Infect Dis</addtitle><date>2011-02</date><risdate>2011</risdate><volume>13</volume><issue>1</issue><spage>63</spage><epage>69</epage><pages>63-69</pages><issn>1398-2273</issn><eissn>1399-3062</eissn><abstract>M.A.B. Trindade, M. de Lourdes Palermo, C. Pagliari, N. Valente, B. Naafs, P.C.B. Massarollo, L.A.C. D'Albuquerque, G. Benard. Leprosy in transplant recipients: report of a case after liver transplantation and review of the literature.
Transpl Infect Dis 2011: 13: 63–69. All rights reserved
: 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.</abstract><cop>Malden, USA</cop><pub>Blackwell Publishing Inc</pub><pmid>20678090</pmid><doi>10.1111/j.1399-3062.2010.00549.x</doi><tpages>7</tpages></addata></record> |
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| ispartof | Transplant infectious disease, 2011-02, Vol.13 (1), p.63-69 |
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| source | MEDLINE; Wiley Online Library Journals Frontfile Complete |
| subjects | Bacilli Biopsy Case reports clofazimine Clofazimine - therapeutic use dapsone Donors Drug Therapy, Combination Enzymes Glucocorticoids - therapeutic use Granuloma Hepatitis Humans Immunosuppression Leprostatic Agents - therapeutic use Leprosy Leprosy, Multibacillary - diagnosis Leprosy, Multibacillary - drug therapy Leprosy, Multibacillary - microbiology Leprosy, Multibacillary - pathology liver transplant Liver transplantation Liver Transplantation - adverse effects Male Middle Aged Mycobacterium leprae Mycobacterium leprae - drug effects Mycobacterium leprae - isolation & purification Neuritis Plaques Prednisone Prednisone - therapeutic use Public health Rifampin Skin Skin - microbiology Skin - pathology Stains Treatment Outcome |
| title | Leprosy in transplant recipients: report of a case after liver transplantation and review of the literature |
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