Hanseníase dimorfa com padrões diversos de reação granulomatosa em pele e vísceras

Abstract

Several patterns of granulomatous reactions in skin, nerves and viscera were seen in a patient with a twelve years history of lepromatous leprosy, showing loss of the eyebrows, saddle nose, fibrosis and atrophy of testes, and ENL episodes. Active lepromatous granuloma, regressive lepromatous granuloma, difuse dimorphous granuloma, and tuberculoid granuloma with a large amount of bacilli including solid bacilli were demonstrated in this patient. Findings of multiple tuberculoid granulomas in limphnodes, bone marrow, liver and spleen were the most interesting aspects. Even though tuberculoid granulomas have predominated the number of bacilli and the presence also of solid bacilli, are indicative of a deterioration of the disease. The authors discuss immunologic interpretation of this type of reactivity and its relation with the bad evolution of the patient.