Reação de tipo pseudo-exacerbação e carcinoma bronquiolar dos pulmões

Abstract

An elderly man with Hansen's disease during a period of twenty years and previously considered as an inactive Virchowian case, presented in the last four years of his life two episodes of reversal reaction (pseudo-exacerbation), the last one at the time of a hospital internation for severe respiratory symptoms. During this internation a diagnosis of bronchiolar carcinoma was made and seven months later the patient died due to progressive respiratory insufficiency. The paper discusses the problems involved in making a differential diagnosis between this particular form of carcinoma and other diseases with similar clinical and X-ray characteristics, as well as the difficulties involved in arriving at the diagnosis of bronchiolar carcinoma only by the means of an evaluation of a single lung biopsy. In relation to the reversal reaction episodes, two different interpretations are contrasted: one being the possibility that these reactions can result as consequences of bacillary growth which can occur in any phase of the infections course in borderline patients due to irregular treatment or drug resistance. The paper also analyses the possible relations between the last reactional episode and secondary immunological changes brought about by the lung tumor.