Miocardiopatia, insuficiência cardíaca e hanseníase tuberculóide reacional

Abstract

60-years-old woman was admitted with congestive hear th failure, essential hyper tension and abdominal distension. Her son repor ted that she appeared with red spots in the body and that she vas under dapsone therapy. Seven months ago there was sudden increase of the skin lesions. In the Ilth day after admission she underwent a stroke that progressed to descerebration and she expired on the four th day. Autopsy confirmed CHF due to chronic myocardi tis related to Chagas'disease. Aneurysm of the api cal region of the lef t vent r icular chamber was also observed leading to thrombosis and systemic embolism with brain and spleen hemor rhagic infarc t. In the encephalous there was edema, uncus herniat ion and hemor rhagic infarct of the brain stem. The skin lesions were due to reactional tuberculoid hanseniasis (RHT) wi th focal les ions in ax i l lary l inphonodes , nasophar ingeal mucosa and in the pos ter ior t ibial nerve. The pathogenesis of RHT is discussed as well as its differentiation with the BT group of Ridley and Jopl ing and it s probably relat ionship with the secondary tuberculoid hanseniasi s repor ted by Ridley. The focal les ions are al so di scus sed wi th END to the involvement of a peripheral nerve trunk what is said to be uncommon in this form os Hansen's disease.