Dados do Trabalho

Título

Median nerve abscess due to leprosy reaction after COVID-19 immunization: A case report.

RESUMO

Case presentation: A 58-year-old woman, previously hypertensive, diagnosed with dimorphic-virchowian leprosy in 2017, underwent multidrug therapy (MDT) for 12 months with multibacillary MB regimen, but had to go through a new treatment cycle due to therapeutic failure at the end of MDT. After 19 months of this second treatment approach, the patient presented with fever, chills, intense arthralgia, edema, and paresthesia in the limbs, besides significant pain in hands and feet and cutaneous erythema nodosum leprosum. A sensory-motor evaluation revealed hyposthesia and paresis, especially in the left hand. No systemic co-infections were identified. However, the patient reported that she received the Oxford/Covishield vaccine against COVID-19 10 days before the onset of the condition. Upper and lower limb peripheral nerve ultrasonography identified marked thickening of the left median nerve. Doppler analysis demonstrated the presence of flow associated with a small hypoechoic image measuring 0.5x0.3 centimeters near the perineurium, compatible with an abscess, in addition to thickening of the tibial, left fibular, and left ulnar nerves.
Discussion: This report discusses a case of a type 2 reaction with neural abscess formation in a patient being treated for dimorphic-virchowian leprosy after receiving Oxford/Covishield immunization. Immune reactions can occur due to an immunological imbalance in leprosy. These reactions are divided into type 1, or reverse reaction, and type 2, or erythema nodosum leprosum and are acute and potentially serious and can constitute a medical emergency due to their morbidity and the worsening of already existing damage. There are some risk factors related to the triggering of those reactions such as co-infections and vaccines. The pathophysiology of leprosy reaction type 2 is still not completely understood, but previous studies show an intense inflammation mediated by humoral immune response, with increased levels of TNF-α. These same mechanisms are possibly involved in the immune response against COVID-19 and may be related to this post-vaccine reaction episode. Final Comments: The reported case serves as an alert to the possible consequences of the pandemic of COVID-19 for leprosy patients. It is necessary to ensure access to immunization for these patients, with increased vigilance after immunization, especially those with multibacillary forms and recurrent leprosy reactions.

Palavras Chave

Leprosy; COVID-19; SARS-CoV-2.