https://doi.org/10.4081/monaldi.2023.2736
Mediastinal lymphadenopathies and skin lesions in a 49-year-old Sinhalese man
Submitted: July 31, 2023
Accepted: September 1, 2023
Published: September 15, 2023
Accepted: September 1, 2023
Abstract Views: 376
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Leprosy is a neglected disease sporadically reported in high-income countries. Skin lesion and peripheral nerve involvement represent most common manifestations. Mediastinal lymphadenopathy in the absence of superficial lymph nodes involvement is very rare. Atypical or rare clinical presentations of disease may delay diagnosis and therapy and cause potential life-threatening manifestations and disabilities. We describe the case of a 49-year-old Sinhalese man who was admitted to our hospital with a one-month history of peripheral neurological symptoms and skin lesions on lower limbs. CT scan showed the presence of mediastinal lymphadenopathies without lung parenchymal and superficial lymph nodes involvement. Endobronchial ultrasound-guided transbronchial needle aspiration showed the presence of granulomas while skin biopsy revealed dermo-hypodermic granulomas with perineural lymphohistiocytic inflammatory reaction. Fite-Faraco staining demonstrated the presence of acid-fast bacilli in both lymph nodal and skin biopsy and polymerase chain reaction was positive for Mycobacterium leprae. Multibacillary leprosy was then diagnosed.
World Health Organization. Regional Office for South-East Asia. Guidelines for the diagnosis, treatment and prevention of leprosy. 2018. Available from: https://apps.who.int/iris/handle/10665/274127
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Britton WJ, Lockwood DN. Leprosy. Lancet 2004;363:1209-19.
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Riccò M, Vezzosi L, Balzarini F, et al. Epidemiology of leprosy in Italy (1920 - 2019): a comprehensive review on existing data. Acta Biomed 2019;90:7-14.
Cavett JR 3rd, McAfee R, Ramzy I. Hansen's disease (leprosy). Diagnosis by aspiration biopsy of lymph nodes. Acta Cytol 1986;30:189-93.
Yang SYS, Leong WMS, Kasunuran CMT, et al. Extensive lepromatous lymphadenitis preceding lesions on the face and earlobes: an unusual presentation of leprosy in Singapore. Case Rep Dermatol 2018;10:35-40.
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Kiran KU, Krishna Moorthy KV, Meher V, Narasimha Rao P. Relapse of leprosy presenting as nodular lymph node swelling. Indian J Dermatol Venereol Leprol 2009;75:177-9.
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Mondoni M, D’Adda A, Terraneo S, et al. Choose the best route: ultrasound-guided transbronchial and transesophageal needle aspiration with echobronchoscope in the diagnosis of mediastinal and pulmonary lesions. Minerva Med 2015;106:S13-9.
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Mondoni M, Saderi L, Puci MV, et al. Xpert MTB/RIF in the diagnosis of mediastinal tuberculous lymphadenitis by endoscopic ultrasound-guided needle aspiration techniques: a systematic review and meta-analysis. Respiration 2023;102:237-46.
DOI: https://doi.org/10.1159/000528947
How to Cite
Cefalo, Jacopo, Carmine Salerni, Giulia Ferranti, Manuela Bimbatti, Laura Moneghini, Paolo Carlucci, Ottavia Viganò, et al. 2023. “Mediastinal Lymphadenopathies and Skin Lesions in a 49-Year-Old Sinhalese Man”. Monaldi Archives for Chest Disease, September. https://doi.org/10.4081/monaldi.2023.2736.
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