[Myocardial disease, heart failure and reactional tuberculoid leprosy]

Area of Science:

• Cardiology
• Neurology
• Dermatology
• Infectious Diseases

Background:

• The case involves a 60-year-old woman with congestive heart failure (CHF), hypertension, and abdominal distension.
• She was undergoing dapsone therapy and presented with worsening skin lesions.

Observation:

• The patient experienced a stroke leading to decerebration and expiration.
• Autopsy revealed chronic myocarditis secondary to Chagas' disease, left ventricular aneurysm, thrombosis, and systemic embolism.
• Hemorrhagic infarcts were noted in the brain and spleen, with cerebral edema and brainstem herniation.

Findings:

• Skin lesions were attributed to reactional tuberculoid hanseniasis (RHT).
• Focal RHT lesions were found in lymph nodes, nasopharyngeal mucosa, and the posterior tibial nerve.
• The study discusses RHT pathogenesis, its differentiation from BT leprosy, and its potential link to secondary tuberculoid hanseniasis.

Implications:

• This case highlights the uncommon involvement of peripheral nerve trunks in RHT.
• It underscores the complex interplay between Chagas' disease and hanseniasis.
• The findings contribute to understanding the pathogenesis and clinical spectrum of these diseases.