Background: Granulomatous pathology is seen in several facial dermatoses, which are diagnosed based on their characteristic clinical features. However, data on their etiology is sparse. Aims & objectives: To determine the prevalence of Mycobacterium leprae (M. leprae) antigen in patients with facial granulomatous pathology by polymerase chain reaction (PCR) and to put forward postulates for this association. Methods: A 3-year retrospective analysis was done for patients presenting with facial granulomatoses between January 2014 & December 2016. The analysed parameters included clinical manifestations, results of investigations including PCR for M. leprae and the outcome of multidrug anti-leprosy therapy in patients who were PCR positive for M. leprae. Results: A total of nine patients (eight females and one male) were included. Mean age was 34 years (range 6–49 years). The average duration of symptoms was 56 (range 3–168) months. Orofacial granulomatosis (OFG)/granulomatous cheilitis was the most common clinical diagnosis seen in 5/9 (56%) patients. Of the remaining four patients, three (33%) presented with a solitary indurated plaque on the face and one patient (11%) had a nodular swelling with a faint hypopigmented rim over the cheek. There were no skin lesions elsewhere in any of the patients. Gum hypertrophy and palatal nodules were seen in 3/5 (60%) patients, each in patients with OFG. Seven patients (78%) were identified to be positive for M. leprae DNA, using PCR targeting the Rlep gene. All seven patients were initiated on anti-leprosy multidrug regimen for 6–12 months with or without steroids. One patient was lost to follow up after 4 months of therapy. The mean duration of follow up in the remaining six patients was 27 (range 12–40) months. Five patients (83%) showed minimal decrease in the swelling at 3 months, but after the end of the therapy there was worsening of the lesions in 3/6 (50%) patients. The patients with smaller lesions showed resolution whereas none of the patients with OFG benefited from the therapy on short term or extended follow up. Limitations: The main limitations of the current study were its retrospective design, small sample size, short follow up period, and no objective clinical assessment. Conclusion: M. leprae was demonstrable by PCR in 78% (7/9) of patients tested, suggesting that it may have a role in the pathogenesis of facial granulomatous disorders in patients living in endemic areas. Treatment with anti-leprosy MDT does lead to sustained improvement in facial granulomatous lesions other than OFG which are positive to M. leprae on PCR, however, the response in OFG is disappointing; it would be advisable to treat them so as to eradicate the pathogen.
BT - Leprosy review IS - 3 J2 - Lepr Rev LA - eng N2 -Background: Granulomatous pathology is seen in several facial dermatoses, which are diagnosed based on their characteristic clinical features. However, data on their etiology is sparse. Aims & objectives: To determine the prevalence of Mycobacterium leprae (M. leprae) antigen in patients with facial granulomatous pathology by polymerase chain reaction (PCR) and to put forward postulates for this association. Methods: A 3-year retrospective analysis was done for patients presenting with facial granulomatoses between January 2014 & December 2016. The analysed parameters included clinical manifestations, results of investigations including PCR for M. leprae and the outcome of multidrug anti-leprosy therapy in patients who were PCR positive for M. leprae. Results: A total of nine patients (eight females and one male) were included. Mean age was 34 years (range 6–49 years). The average duration of symptoms was 56 (range 3–168) months. Orofacial granulomatosis (OFG)/granulomatous cheilitis was the most common clinical diagnosis seen in 5/9 (56%) patients. Of the remaining four patients, three (33%) presented with a solitary indurated plaque on the face and one patient (11%) had a nodular swelling with a faint hypopigmented rim over the cheek. There were no skin lesions elsewhere in any of the patients. Gum hypertrophy and palatal nodules were seen in 3/5 (60%) patients, each in patients with OFG. Seven patients (78%) were identified to be positive for M. leprae DNA, using PCR targeting the Rlep gene. All seven patients were initiated on anti-leprosy multidrug regimen for 6–12 months with or without steroids. One patient was lost to follow up after 4 months of therapy. The mean duration of follow up in the remaining six patients was 27 (range 12–40) months. Five patients (83%) showed minimal decrease in the swelling at 3 months, but after the end of the therapy there was worsening of the lesions in 3/6 (50%) patients. The patients with smaller lesions showed resolution whereas none of the patients with OFG benefited from the therapy on short term or extended follow up. Limitations: The main limitations of the current study were its retrospective design, small sample size, short follow up period, and no objective clinical assessment. Conclusion: M. leprae was demonstrable by PCR in 78% (7/9) of patients tested, suggesting that it may have a role in the pathogenesis of facial granulomatous disorders in patients living in endemic areas. Treatment with anti-leprosy MDT does lead to sustained improvement in facial granulomatous lesions other than OFG which are positive to M. leprae on PCR, however, the response in OFG is disappointing; it would be advisable to treat them so as to eradicate the pathogen.
PY - 2018 SP - 280 EP - 288 T2 - Leprosy review TI - The role of PCR for Mycobacterium leprae in patients with facial granulomatoses: A pilot study VL - 89 ER -