Septicemia com múltiplas lesões ósseas supurativas como complicação do eritema nodoso hansênico

Abstract

Since the first admission to the hospital a 57-year-old male with Hnsen's disease for 26 years and still active, undergo several episodes of ENL some of then with neuritis, lymphadenitis, jaundice and anemia. He also developped ulcers in the upper and lower limbs with secondary infection and necrosis with exposition of muscles and bones. In the last admission with ENL the main features were abscesses in the buttocks, bone pain in the lower limb, right iliac crest and chest, difficulty to void with progressive diminution of the urinary volume, febrile pickes, melena, abdominal distension and, more recently, respiratory distress. The laboratory test revealed decrease of hemoglobin (10.7-5.1 g%) and leucocytes (9,9003,700 mm3); vertebral osteoporosis with partial collapse of the D4, D5 and D11 vertebral bodies and slight signs of osteomyelitis in the tibia and fibula. The autopsy revealed the patient as a regressive lepromatous case with a small number of granular bacilli in nerver trunks and axillary lymph nodes. No active lesions of ENL were detected in the skin, nerves or viscera, only a spot of necrosis and suppuration in organization was found in an axillary lymph node. The patient died of septic shock due to several necrotizing and suppurative lesions in the vertebral bodies, costal arches and clavicles. The rupture of an costal abscess into the right hemithorax lead to severe serofibrinous purulent pleuritis. Thrombosis of the right axillary vein was observed as well as in the inferior cava close to the opening of the suprahepatic veins and also thrombosis of the right atrium. Acute ulcerative necrotizing and phlegmonous colitis in the cecum, a nodule of cryptococcosis in the left lung and prostatic nodular hyperplasia were also observed in the autopsy. We discuss the relationship of ENL with the set up of a septicemia and its possible connection with secondary infection in the skin lesions of ENL, the immune depressed status of the patient facing recurrent episodes of ENL and the role of corticoesteroid in the diminution of resistence to common and opportunistic pathogenic microorganisms.