technetium-tc-99m-medronate and Leprosy

Mutilation of extremities was very frequent in patients affected by leprosy in the past; although it is now much less common, it is still seen, mainly in patients with long-term disease. In general, mutilation of the nose and ears is caused by the bacillus and mutilation of the hands and feet a consequence of chronic trauma. Leprosy must be chronically treated and any decision to interrupt therapy is based on laboratory tests and biopsy. Scintigraphy is a non-invasive procedure which could be of great value in to determining disease activity. We studied eight patients (five males and three females, aged 64-73 years) who presented with mutilation of the nose (2), ear (1), feet (3) or foot and hand (2). Conventional three-phase bone scintigraphy (750 MBq) and X-ray examinations of the affected areas were performed in all patients. Bone scintigraphy was abnormal in four patients (the presence of bacilli was confirmed by biopsy in two of them), and normal in the other four. In all patients except for the one with ear mutilation, radiography only showed the absence of bone. We conclude that bone scintigraphy is very useful to determine disease activity in cases of mutilation caused by leprosy. It seems to be superior to conventional radiography and may enable bone biopsies to be avoided.

Topics: Aged; Bone and Bones; Female; Humans; Leprosy; Male; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Topics: Adult; Bone and Bones; Female; Gamma Cameras; Humans; Leprosy; Male; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Medronate

Gallium 67 imaging was used in 12 patients with documented Hansen's disease undergoing treatment or not, in an attempt to determine the pattern of the disease. Diagnosis was confirmed by histopathology in all patients. The Mitsuda reaction was seen in all patients. Specific nuclear studies were performed when needed to evaluate particular organs better. Gallium 67 images show homogeneous, diffuse and moderate accumulation over the entire skin surface (except for the face) of untreated patients with multibacillary disease. The facial skin in these cases presented homogeneous, diffuse but very marked uptake of gallium. Internal organ involvement was variable. There was a very good correlation among clinical, scintigraphic, immunological and histopathological data. The pattern of the body skin ("skin outlining") and facial skin ("beard distribution") may be distinct for untreated patients with multibacillary leprosy.

Topics: Adult; Bone and Bones; Female; Gallium Radioisotopes; Humans; Leprosy; Liver; Lung; Male; Radionuclide Imaging; Skin; Spleen; Technetium Tc 99m Medronate; Technetium Tc 99m Sulfur Colloid

Leprosy is a disease that is widely distributed in underdeveloped tropical regions, with cases also occurring in the United States. The bone scan findings in a patient with leprosy who had developed a reactional state of the disease, erythema nodosum leprosum, are presented. His scan showed bilaterally symmetrical double stripe signs involving the distal tibias, similar to those seen in hypertrophic osteoarthropathy. Physicians should be aware that this reactive phase of leprosy can also produce the double stripe sign.

Topics: Adult; Bone and Bones; Erythema Nodosum; Humans; Leprosy; Male; Radionuclide Imaging; Technetium Tc 99m Medronate