title: A patient with erythema nodosus leprosum and Chagas cardiopathy: challenges in patient management and review of the literature.
abstract: We report a patient with severe multi-bacillary leprosy complicated by recurrent episodes of erythema nodosum necrotisans that required thalidomide and/or corticosteroids during follow-up. Although the patient was from an area to which Chagas disease is endemic, this diagnosis was initially missed and was only investigated when heart failure developed in the patient. The difficulties of managing erythema nodosum necrotisans and heart failure concomitantly and those involved in excluding the diagnosis of acute myocarditis caused by reactivation of Chagas disease secondary to the immunosuppressive regimen are discussed. Other potential causes for the heart failure and possible interactions between the two diseases and their treatments are discussed. We also reviewed the literature for the association between leprosy and Chagas disease, both of which are highly endemic in Brazil. This case emphasizes the importance of searching for subclinical co-infections in leprosy patients because reactions frequently develop during specific treatment in these patients, and these reactions require prolonged therapy with immunosuppressive drugs.
authors.affiliation: Division of Clinical Dermatology, and Division of Infectious Diseases, Clinics Hospital, Medical School, University of Sao Paulo, SP, Brazil. angelatrindade@uol.com.br
authors.forename: Maria Ângela B
authors.initials: MÂ
authors.lastname: Trindade
authors.forename: Noemia B
authors.initials: NB
authors.lastname: Carvalho
authors.forename: Elaini C
authors.initials: EC
authors.lastname: Belfort
authors.forename: Carla
authors.initials: C
authors.lastname: Pagliari
authors.forename: Erika
authors.initials: E
authors.lastname: Gakiya
authors.forename: Neusa Y
authors.initials: NY
authors.lastname: Sakai-Valente
authors.forename: Gil
authors.initials: G
authors.lastname: Benard
authors.forename: Maria A
authors.initials: MA
authors.lastname: Shikanai-Yasuda
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D002598:Chagas Cardiomyopathy / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D004893:Erythema Nodosum / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007917:Leprostatic Agents / Q000627:therapeutic use; D015440:Leprosy, Lepromatous / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D008875:Middle Aged; D013792:Thalidomide / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D007917:Leprostatic Agents; D013792:Thalidomide