Biological agents: investigation into leprosy and other infectious\ndiseases before indication
Male patient, aged 49, white, mason, from the municipality of Auriflama, State of São\nPaulo, Brazil. The patient underwent follow-up in the rheumatology department at the\nBase Hospital of São José do Rio Preto, diagnosed with rheumatoid arthritis 15 years\nago, refractory to conventional treatments. Therapy was initiated using infliximab and,\nafter four doses of this anti-TNF a biological agent, with a total dose of 1600mg,\nduring the physical exam, erythematous plaques were discovered in the dorsal region and\nthe left forearm, with respective diameters of 8 and 5cm; and erythematous violaceous\nplaques in the left thigh, with diameters of 4 x 6cm, and diminished sensitivity in\nthese lesions ( and ). The patient experienced increases in the number and diameter of\nthe erythematous violaceous plaques in the midsection and limbs. The patient presented\npositive family epidemiology for leprosy.\nThe biopsy of the cutaneous lesions on the back and left thigh revealed borderline\nleprosy, with a tendency toward the lepromatous pole, with whole, resistant alcohol-acid\nresistant bacilli (particularly in nerves), a lymph smear (AARB) and positive Mitsuda\ntest, with a diameter of 11mm (). The\nclinical classification, following the result of the Mitsuda test, was reactional\ntuberculoid leprosy and the patient developed a clinical, downgrading reverse reaction,\nsimilar anatomopathologically to dimorphous leprosy. The anti-TNF therapy was\ninterrupted and a specific treatment for leprosy was started with multibacillary\npolychemotherapy (PCT/MB/WHO), presenting significant improvement in the clinical\nleprosy.