Coinfecção hanseníase-leishmaniose

Relatar dificuldades diagnosticas face a ocorrencia simultânea, num mesmo paciente,de duas enfermidades infecciosas com aspectos clinicos semelhantes. Relato de caso: homemde 21 anos, ha nove meses apresentando placas eritematoviolaceas infiltradas na face, dorso e pedireito. A histopatologia de uma lesao do dorso evidenciou quadro de dermatite granulomatosa,com pesquisa de bacilos alcool-acido resistentes negativa a coloracao de Fite-Faraco. Umdiagnostico de hanseniase dimorfo-tuberculoide foi realizado e o paciente submetido apoliquimioterapia multibacilar. As lesoes do pe direito evoluiram com ulceracao e pesquisadireta positiva para formas amastigotas de Leishmania spp; entretanto, um exame imunohistoquimicodo material emblocado da biopsia anterior, do dorso, mostrou resultado negativocom anticorpo antileishmania, Consideracoes finais: A conclusao diagnostica de coinfeccaohanseniase-leishmaniose tegumentar para o caso apresentado, somente foi possivel gracas acorrelacao clinico-patologica e realizacao de provas histoquimicas e imuno-histoquimicas.(AU) To report diagnostic difficulties that may arise when a simultaneous occurrence oftwo infectious diseases presenting similar clinical features takes place in a single patient. Casereport: a 21-year-old male presented with violaceous, infiltrated plaques on his face, dorsumand right foot. A granulomatous dermatitis was diagnosed histologically in a biopsy taken fromthe dorsum, with no demonstrable acid-fast organisms on Fite-Faraco stain. A diagnosis ofbordeline-tuberculoid leprosy was concluded, and the patient was given multibacillarypolychemotherapy. The lesions on the right foot became ulcerated, and positive smears forLeishmania spp amastigotes were obtained. However, immunohistochemistry failed todemonstrate leishmania antigens in recuts of the paraffin-embedded material from the originaldorsal biopsy. Final considerations: the diagnosis of leprosy-leishmaniasis coinfection to thiscase has been possible only after clinical-pathological correlation as well as histochemical andimmunohistochemical procedures were carried out(AU)