BACKGROUND

Efforts to control Hansen's d isease have progressed through multidrug therapy implementation. However, documented cases of relapse present challenges to its effective management and eradication. Understanding the contributing factors to relapse is crucial for optimizing treatment strategies and achieving better outcomes against Hansen's Disease.

OBJECTIVE

To determine the epidemiological profile and clinical patterns of patients diagnosed with Hansen's Disease Relapse in selected Tertiary Government Hospitals in the Philippines from November 2016 to October 2021.

METHODOLOGY

This was a multi-center, retrospective study involving a five-year chart review method. Charts of all Hansen's Disease Relapse patients were obtained from participating institutions with necessary approvals. Data collection followed approved forms, and patient profiles were analyzed using descriptive statistics. Pre- and post- relapse profiles were compared using T-tests, Wilcoxon tests, and Fisher's Exact Test. Relapse time across subgroups were assessed using Kruskal-Wallis and Mann-Whitney U tests.

RESULTS

A total of 60 relapse cases were included in the study. Majority were single, unemployed males aged 26-35, with low household screening. The Bacillary Index significantly decreased post- relapse. Documented comorbidities included G6PD deficiency before treatment and lepra reactions during MDT. Patients on 12-month MDT regimens had higher relapse time than those on 24-month regimens.

CONCLUSION

This study underscores the influence of socioeconomic, gender, and age-related factors on relapse. It emphasizes the imperative for enhanced public health measures in accordance with the WHO Global Leprosy Strategy and the importance of considering clinical factors while advocating for continuous improvements in leprosy management protocols.

Human ; Multiple Chronic Conditions

Sweet syndrome, or acute febrile neutrophilic dermatosis, is a rare inflammatory condition characterized by painful erythematous plaques, fever, and neutrophilia. While it is often associated with malignancy or drug reactions, it may also occur following streptococcal infection. This case highlights the importance of early recognition and treatment of Sweet syndrome secondary to streptococcal pharyngitis.

A 44-year-old female presented with painful erythematous papules and nodules on her extremities, neck, and nape, associated with fever and chills. The lesions started as skin-colored papules that rapidly progressed to painful erythematous plaques. Her medical history included a sore throat two weeks prior. Initial management Clindamycin provided temporary relief, but the lesions persisted. Laboratory work revealed neutrophilic leukocytosis, elevated erythrocyte sedimentation rate (ESR), and an elevated anti-streptolysin O titer. A skin biopsy showed diffuse neutrophilic dermatitis with vasculitis, confirming the diagnosis of Sweet syndrome. Subsequent treatment with oral corticosteroids led to significant clinical improvement over a week.

This case illustrates the importance of considering infectious triggers, such as streptococcal infections, in the diagnosis of Sweet syndrome. Early diagnosis and appropriate treatment with corticosteroids are essential in preventing complications. Reporting this case contributes to the understanding of non-malignant triggers of Sweet syndrome and underscores the need for heightened awareness of this rare condition in patients presenting with acute febrile dermatosis.

Human ; Female ; Adult: 25-44 Yrs Old ; Sweet Syndrome

Angiokeratomas are present in approximately 0.16% of the population, with only 14% classified as the Fordyce type. Angiokeratomas of Fordyce are mainly found on the scrotum, with very rare occurrences on the glans penis or penile shaft. Currently, there are no established guidelines in the management of angiokeratomas. Since angiokeratomas are vascular in nature, lasers which target the chromophore oxyhemoglobin can be used, hence the use of the 578-nm yellow laser in this case.

This is a case of a 34-year-old Filipino male with a 22-year history of violaceous papules on the penile shaft gradually increasing in size, with complaints of bleeding from the lesions during coitus, significantly affecting the patient’s quality of life. Physical examination revealed few, well-defined, round, violaceous hyperkeratotic papules on the penile shaft, the largest measuring 4x4x4 mm. Dermoscopy revealed several, well-demarcated, round, erythematous to violaceous lacunae with whitish veil. Histopathology also revealed findings consistent with angiokeratoma.

Non-scrotal or penile angiokeratoma of Fordyce is a very rare benign vascular tumor that can adversely affect patients’ quality of life, particularly due to the potential discomfort brought about by bleeding during coitus. Traditional therapeutic modalities may lead to scarring, hence the emerging trend on the use of vascular lasers. After two sessions of yellow laser, our patient expressed satisfaction with the results with an improved overall quality of life. The effectiveness, minimal scarring potential, and relatively safe side effect profile of these vascular lasers make them a promising treatment option for angiokeratomas.

Human ; Male ; Adult: 25-44 Yrs Old ; Angiokeratoma

Lymphangioma is a rare vascular malformation, comprising about 4% of such anomalies. Its most common symptom is swelling, which often leads to cosmetic deformity. The most prevalent subtype, lymphangioma circumscriptum, seldom presents on the vulvar area, making treatment especially challenging due to potential complications and recurrence risks.

This is a case of a 10-year-old Filipino female, otherwise healthy, who presented with progressively enlarging, tender, “frog spawn”-like papules on the left vulva since birth. These papules showed partial improvement following surgical excision. Histopathological examination confirmed the diagnosis of lymphangioma. Over the past year, the patient experienced recurrence of papules, resulting in vulvar asymmetry and labial swelling. Pelvic magnetic resonance imaging (MRI), ultrasound, and fine needle aspiration biopsy, revealed multiple superficial and deep cystic masses consistent with lymphangioma. Long-pulsed Nd:YAG laser was administered to the external lesions, yielding partial improvement. Subsequently, she underwent ultrasound-guided sclerotherapy with bleomycin under local anesthesia.

This procedure, performed by interventional radiology, successfully resolved the deep cysts and swelling after two sessions, with no reported complications.

In cases of cutaneous lymphangioma, especially in anatomically sensitive regions like the vulva, imaging plays a crucial role in determining lesion depth and guiding treatment to minimize recurrences. Although no local literature is available, this case highlights the effectiveness and safety of ultrasound-guided sclerotherapy with bleomycin as a novel treatment option for lymphangioma.

Human ; Female ; Child: 6-12 Yrs Old ; Lymphangioma ; Sclerotherapy