scholarly journals 812. Case–Control Trial to Evaluate the Cytokine Response to the Use of Capsule Thalidomide in Erythema Nodosum Leprosum in Leprosy Patients

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S290-S291
Author(s):  
Ajay Chopra ◽  
Debdeep Mitra ◽  
Barnali Mitra
Keyword(s):  
Immune Response ◽  
Erythema Nodosum ◽  
Skin Lesions ◽  
Interferon Γ ◽  
Controlled Study ◽  
Type Ii ◽  
Drug Of Choice ◽  
Erythema Nodosum Leprosum ◽  
Tnf Α ◽  
Systemic Symptoms

Abstract Background Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. Type II lepra reaction or Erythema Nodosum Leposum is a Type III hypersentivity immune response during the chronic course of the illness. This immune response presents as systemic symptoms and neutrophilic leukocytosis, similar to sepsis. Capsule Thalidomide is considered the drug of choice, when it comes to the treatment of this acute immunological emergency. A rational study into the immunological markers involved in the pathogenesis of erythema nododsum leprosum and its successful suppression by Thalidomide should be helpful in early diagnosis and prompt successful therapy. On the basis of previous studies, our aim was to find a correlation with interferon-γ, tumour necrosis factor-α, and Cd-64 expression on activated circulating neutrophils during Type II lepra reaction and successful response to capsule Thalidomide. Methods This case-controlled study included one group of patients diagnosed to have leprosy and the other group was healthy controlled individuals with matched age, sex, and area of residence. All the patients with type II lepra reaction responded to Capsule Thalidomide clinically, and all the skin lesions resolved in 7–14 days. Blood samples and skin biopsy were subjected to histopathology, immunoflourescence assay, immunohistochemical staining, quantitative RT-PCR (reverse transcriptase-polymerase chain reaction), and flow cytometry. Results Interferon-γ and TNF-α are sensitive markers in diagnosing erythema nodosum leprosum and Cd-64 expression on activated circulating neutrophils is both a specific and sensitive marker in Type II lepra reaction. Cd-64 expression also had a positive correlation with Thalidomide treatment and clinical response. High polymorphonuclear Cd-64 expression was correlated with severity of ENL. Conclusion Cd-64 expression on circulating neutrophils is a potential early biophysical marker for diagnosing erythema nodosum leprosum and can be used as a tool to assess thalidomide response. It is however not a good index to diagnose leprosy infection as it was specific for Type II lepra reaction. Interferon-γ and TNF-α are sensitive markers to screen for lepra reactions and this study showed no significant correlation with Thalidomide therapy. Disclosures All authors: No reported disclosures.

Severe hypoxemia in the absence of blood loss causes a gender dimorphic immune response

2000 ◽  
Vol 279 (6) ◽  
pp. C2004-C2010 ◽  
Author(s):  
Markus W. Knöferl ◽  
Doraid Jarrar ◽  
Martin G. Schwacha ◽  
Martin K. Angele ◽  
William G. Cioffi ◽  
...  
Keyword(s):  
Immune Response ◽  
Blood Loss ◽  
Inflammatory Response ◽  
Interferon Γ ◽  
Systemic Inflammatory Response ◽  
Severe Hypoxemia ◽  
Splenic Macrophage ◽  
Tnf Α ◽  
Severe Hemorrhage ◽  
Tissue Trauma

A gender dimorphic immune response has been observed after trauma and severe hemorrhage, a condition believed to be associated with tissue hypoxia. Although studies have shown that hypoxemia per se in males causes a systemic inflammatory response, it is unclear if the inflammatory response to hypoxemia exhibits gender dimorphic characteristics. To study this, male and female C3H/HeN mice in the proestrus state of the estrous cycle were subjected to hypoxemia (95% N2-5% O2) or sham hypoxemia (room air) for 60 min. Later (2 h), plasma interleukin (IL)-6 and tumor necrosis factor (TNF)-α levels were determined along with splenic immune responses. Plasma IL-6 and TNF-α concentrations after hypoxemia were significantly increased in males but not in females. Splenocyte proliferation was depressed in males after hypoxemia but not in females. A shift toward an immunosuppressive Th-2 cytokine profile was observed in males after hypoxemia [decreased interferon-γ (Th-1) and increased IL-10 (Th-2)], whereas no such shift was observed in females. Splenic macrophage IL-6, IL-10, and IL-12 production were suppressed in males after hypoxemia; however, such suppression was not observed in females. These findings therefore indicate that a gender dimorphic immune response also exists after hypoxemia in the absence of blood loss and tissue trauma, similar to trauma-hemorrhage. Furthermore, because no systemic inflammatory response or alterations in T lymphocyte or macrophage functions are observed in proestrus females but such parameters are markedly altered after severe hypoxemia in males, these studies indicate that proestrus females can tolerate hypoxemia better than males.

scholarly journals Cutaneous Leishmaniasis in Naturally Infected Dogs is Associated with a T Helper-2-biased Immune Response

2005 ◽  
Vol 42 (2) ◽  
pp. 166-175 ◽  
Author(s):  
C. Brachelente ◽  
N. Müller ◽  
M. G. Doherr ◽  
U. Sattler ◽  
M. Welle
Keyword(s):  
Immune Response ◽  
Parasite Burden ◽  
Skin Lesions ◽  
Cytokine Expression ◽  
T Helper ◽  
T Helper 2 ◽  
Th2 Cytokine ◽  
Tnf Α ◽  
Skin Biopsies ◽  
Ifn Γ

Skin lesions are a frequent manifestation of Leishmania infantum infections in Mediterranean countries. This study demonstrates by real-time reverse transcriptase-polymerase chain reaction the local cytokine response in skin biopsies from Leishmania-infected dogs ( n = 10). As controls, we investigated skin biopsies from healthy ( n = 10) and fleabite hypersensitive dogs (n = 10). We established a quantitative PCR to determine the parasite burden in biopsies. The objective was to elucidate whether a correlation exists between parasite number, histologic response, and T helper-1 (TH1)/T helper-2 (TH2) cytokine expression in lesional skin of naturally infected dogs. In Leishmania-infected dogs, interleukin-4 (IL-4), tumor necrosis factor α (TNF-α) and interferon-γ (IFN-γ) messenger RNA production was significantly higher than controls. Furthermore, dogs with a high Leishmania burden had a significantly higher IL-4 expression, whereas no difference was noted with regard to expression of other cytokines. By comparing the pattern of inflammation and cytokine expression, a clear trend became evident in that levels of IL-4, TNF-α, and IFN-γ were elevated in biopsies with a periadnexal nodular pattern and in biopsies where the severity of the periadnexal infiltrate was equal to the perivascular to interstitial infiltrate. Expression of IL-4, IL-13, and TNF-α was slightly increased in biopsies where plasma cells prevailed on lymphocytes, whereas expression of IFN-γ was moderately higher when lymphocytes were predominating. In summary, the present study demonstrates that the local immune response in naturally occurring leishmaniasis includes TH1 as well as TH2 cytokine subsets. Furthermore, respective data suggest that increased expression of the TH2-type cytokine IL-4 is associated with both severe clinical signs and a high parasite burden in the skin lesions.

Canadian Case Report of Erythema Nodosum Leprosum Successfully Treated with Prednisone and Thalidomide

2010 ◽  
Vol 14 (2) ◽  
pp. 95-99 ◽  
Author(s):  
Mélissa Saber ◽  
Caroline Bourassa-Fulop ◽  
Danielle Bouffard ◽  
Nathalie Provost
Keyword(s):  
Case Report ◽  
Erythema Nodosum ◽  
Term Treatment ◽  
Response To Treatment ◽  
Cutaneous Lesions ◽  
Erythema Nodosum Leprosum ◽  
Long Term Treatment ◽  
The Face ◽  
Systemic Symptoms

Background: Erythema nodosum leprosum (ENL) is a disease rarely encountered in Canada. It is characterized by multiple remissions and recurrences, often requires long-term treatment, and can result in debilitating sequelae. Objective: To promote rapid recognition and adequate therapy for ENL. Methods: Case report of a 39-year-old man diagnosed with an ENL. The clinical and histopathologic features, treatment provided, and response to treatment are detailed in this article. Results: ENL presented itself as painful cutaneous lesions on the face and limbs, bilateral paresthesia of the fourth and fifth fingers, and systemic symptoms. Prednisone 40 mg daily for a week and then 60 mg daily for another week reduced the lesions by 80% and the pain by 50%. Although prednisone 60 mg daily was continued for one more week and then stopped, thalidomide was started at a dose of 300 mg daily for 4 weeks and then reduced gradually, which led to complete resolution. Conclusion: At the 7½-month follow-up, the patient remained completely asymptomatic.

An uncommon variant of erythema nodosum leprosum responding well to methotrexate: Report of two cases

2021 ◽  
pp. 004947552110166
Author(s):  
Seema Rani ◽  
Sweta Singh ◽  
Diksha Agrawal ◽  
Kabir Sardana ◽  
Arvind Ahuja
Keyword(s):  
Low Dose ◽  
Erythema Nodosum ◽  
Type I ◽  
Type Ii ◽  
Permanent Disability ◽  
Atypical Features ◽  
Erythema Nodosum Leprosum

Reactions in leprosy are acute inflammatory episodes that can be classified as type I or type II. Recognition and timely management of these patients is critical to avoid permanent disability. We present two cases of erythema nodosum leprosum, presenting with recurrent atypical features, responding well to a low dose of methotrexate.

scholarly journals Erythema Nodosum Leprosum Neutrophil Subset Expressing IL-10R1 Transmigrates into Skin Lesions and Responds to IL-10

2020 ◽  
Vol 4 (2) ◽  
pp. 47-56 ◽  
Author(s):  
Fabiana Santos Pacheco ◽  
Rhana Berto da Silva Prata ◽  
Sheila Santos Brandão ◽  
Helen Ferreira ◽  
Thaís Fernanda Rodrigues ◽  
...  
Keyword(s):  
Erythema Nodosum ◽  
Skin Lesions ◽  
Erythema Nodosum Leprosum

scholarly journals Interruption of Sneddon-Wilkinson Subcorneal Pustulation with Infliximab

2017 ◽  
Vol 9 (1) ◽  
pp. 140-144 ◽  
Author(s):  
Lorenz Kretschmer ◽  
Julia-Tatjana Maul ◽  
Thomas Hofer ◽  
Alexander A. Navarini
Keyword(s):  
Maintenance Therapy ◽  
Skin Lesions ◽  
First Line ◽  
First Line Therapy ◽  
Tnf Α ◽  
Subcorneal Pustular Dermatosis ◽  
Severe Manifestation ◽  
Chemotactic Factors ◽  
Systemic Symptoms

Subcorneal pustular dermatosis (SCPD, Sneddon-Wilkinson disease) is a rare chronic-relapsing skin disorder that typically manifests as flaccid sterile pustules without systemic symptoms. Although the accumulation of neutrophils is acknowledged to be a hallmark of SCPD, its exact pathomechanism is still not known. Several chemotactic factors have been implicated in neutrophil recruitment and invasion, including the proinflammatory cytokine TNF-α. These findings correspond well with clinical reports of successful off-label use of TNF blocking agents in cases that were refractory to first-line therapy, mostly with dapsone. We report the case of a 29-year-old male with atypical and severe manifestation of SCPD that resolved after a single dose of infliximab. Consolidation was observed 1 day after treatment and regression of skin lesions occurred after a few days. Residual scarring and postlesional hyperpigmentation was seen at a 2-month follow-up appointment. The patient was initiated on a daily maintenance therapy with dapsone, which led to a drop in hemoglobin and had to be stopped. Upon development of small, scaly lesions, a maintenance therapy with infliximab was started and the patient has had no recurrence to date. Anti-TNF agents present a promising option for patients affected by severe SCPD. We review the reports of similar cases in the literature to date.

scholarly journals Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) Associated with Mycoplasma pneumoniae Infection

2020 ◽  
Vol 12 (3) ◽  
pp. 225-230
Author(s):  
Guy Shalom ◽  
Raed Khoury ◽  
Amir Horev
Keyword(s):  
Drug Reaction ◽  
Mycoplasma Pneumoniae ◽  
Drug Allergy ◽  
Drug Eruption ◽  
Interferon Γ ◽  
Mycoplasma Infection ◽  
Release Test ◽  
Tnf Α ◽  
Systemic Symptoms

Mycoplasma infection may lower the threshold for drug allergy in particular patients. We present a case of drug reaction with eosinophilia and systemic symptoms (DRESS), with drug etiology and non-drug etiology (Mycoplasma infection). Possible synergism between previously known drug allergy and the acute Mycoplasma infection may have led to DRESS eruption. Interferon-γ release test and TNF-α release test yielded different patterns in the present case, suggesting a different role for each in different drug eruption types.

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