Dados do Trabalho

Title

AVALIATION,THROUGH ULTRASONOGRAPHY,OF CHRONIC PANUVEITIS SECONDARY TO LEPROSY,TREATED WITH METHOTREXATE:CASE REPORT

Background

The leprosy is an infectious chronic disease caused by Mycobacterium leprae, whose contamination is caused through the contact of individual by individual bacilli eliminated on the oral and nasal route. The main regions of involvement are skin, nerves, articulations and eyes. It is extremely aggressive and incapacitating, and may occur in paucibacillary and multibacillary form, according with the individual’s immunological resistance. Leprosy is considered one of the diseases that cause more ocular manifestations and symptoms like connective tissue disorders. The bacillus mainly affects the trigeminal and facial nerves. It can cause inflammation of vascular tissues of the eyes, resulting in anterior and posterior uveitis besides blindness . In multibacillary forms the eye is invaded by the bacillus through the bloodstream resulting in bilateral involvement with the formation of conjunctival nodules and, subsequently, impairment of the cornea and uvea. The posterior uveitis occurs more rarely affecting the retina, choroid, and vitreous. Ultrasonography an imaging method is used to evaluate pathologies of the eye and its segment after treatment.

Case report

37 years old, male, retired, diagnosed with multibacillary leprosy for 8 years ago when he presented skin lesions, polyarthritis of the hands, wrists and knees, having made multidrug therapy (MDT) for 1 year and high-dose prednisone. After 5 years of initial treatment, he developed pain, visual haze and ocular hyperemia, being diagnosed with panuveitis. He sought the ophthalmologic service being treated with oral and intraocular corticosteroids, reporting low improvement, and was referred to a rheumatologist. Subsequently, he initiated oral methotrexate 15mg / week associated with folic acid 5mg / week with good clinical improvement, presenting regression of the total ophthalmologic picture in the left and partial in the right eye in anterior chamber, according to ultrasonography, performed by us.

Conclusion

Ultrasonography presents as an affordable, low cost method and is ideal for diagnosis and follow-up of ocular pathologies such as uveitis. The patient under discussion was treated with methotrexate, an antimetabolite, which is one of the main drugs involved in the treatment of uveitis, with the objective of abolishing the inflammatory process and avoiding important eye sequelae such as blindness. Subsequently, it was reassessed by ultrasonography, that showed excellent therapeutic response.