A Tuberculoid Leprosy Case with Ulcers of her Patches
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概要
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A female case 56 years old had the variously sized erythemata on her face, neck, buttock, and extremities. They were from coin-sized to twice the size of palm. Some patches had the apparently normal area in their inner part. In addition to those erythemata, the papules which were from marking-pin-head-sized to lens-sized, well-defined, hemispherically raised, and hard were scattered on the back of both hands, fingers, lower arms, legs, and neck.The macroscopical findings that the skin lesions were multiple, some eruptions were small in size, and some patches had the punched-out appearance suggested us the borderline nature of skin lesions. But the skin biopsy revealed the typical tuberculoid features. The bacteriological examination of skin lesions were negative, and the Mitsuda-test was positive. The small dosis of CIBA 1906 was given to her every day, except for the 1 st week when CIBA 1906 was given 5 days a week. About 5 weeks after the start of chemotherapy, the remarkable desquamation appeared on the patches of legs. And about 4 weeks later, two ulcers came out on the patches of the right leg. Thereafter, the ulcers expanded gradually, and new other ulcers appeared on both legs. About 3 months after the start of chemotherapy, the drug was changed from CIBA 1906 to DDS. But the ulcers did not improve. By the suspicion of skin tuberculosis, INH and PAS were administered, but they had no effect. The biopsy of a nerve which was enlarged revealed the tuberculoid change in the nerve. This result decided that she had the leprosy. Besides, the skin reaction against PPD was not positive, and the cultivation of tubercle bacilli from a eruption was negative. And also the comparative study of macroscopical and microscopical findings of skin eruptions denied the combination of skin tuberculosis. The mycotic dermatitis, syphilis, and the ulcer caused by Mycobacterium ulcerans were denied, too. Thus, it was fixed that they were the ulcers which came out on the leprous tuberculoid patches. About 6 months after the appearance of ulcers, they were cured.The literatures on the lazarine leprosy were reviewed in this paper. This case is similar to neither Mexican type of lazarine leprosy nor Cuban type, and similar to the cases reported by Ryrie, and Ota and Sato.The term "lazarine leprosy" should not be used hereafter, because many confusions arose concerning the interpretation of "lazarine leprosy". The terms "Lucio's leprosy" and "Pachá's leprosy" should be used. The former means the spotted leprosy with ulcers in diffuse lepromatous case reported first by Lucio, and the latter expresses the monosymptomatic case having destructive ulcer reported first by Pachá.
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