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and thickening and pain on palpation of the left ulnar and left external sciatic popliteal nerves&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The bacilloscopy of the ear and two trunk lesions was positive &#40;smear index&#58; 3&#46;33&#41;&#46; Histopathology of the plaque in the inguinal region showed an epidermis with hyperkeratosis&#59; in the dermis&#44; edema and a perivascular&#44; periadnexal&#44; and interstitial mild inflammatory infiltrate composed of lymphocytes&#44; histiocytes&#44; plasmocytes&#44; epithelioid cells&#44; and sparse giant Langhans cells&#44; involving the subcutaneous tissue&#44; adipocytes and septa&#46; Wade staining showed a large number of intracellular acid-fast bacilli&#44; grouped in globi&#44; fragmented and granular &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A and <a class="elsevierStyleCrossRef" href="#fig0015">3</a> B&#41;&#46; PAS staining did not show thickening of the basal membrane&#44; and no mucin was observed in the Alcian blue staining&#46; 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of the patients with lepromatous leprosy&#59; in 23&#46;6&#37; of those with tuberculoid borderline&#59; in 18&#46;2&#37; of those with borderline forms&#59; and in 16&#46;4&#37; of those with borderline lepromatous type&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Positive ANA can be observed in 3&#37; to 34&#37; of leprosy patients&#46; Titers are generally low&#44; and the speckled and homogeneous patterns are the most common&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Rheumatoid factor&#44; anti-CCP&#44; ANCA&#44; anti-cardiolipin&#44; and antiphospholipids have been observed in varying percentages in patients with the different forms of leprosy&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;8</span></a> Non-scarring alopecia&#44; especially in patients with the lepromatous leprosy&#44; has already been described&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The different clinical manifestations of leprosy pose a diagnostic challenge&#44; since they can mimic other diseases&#44; including autoimmune disorders&#46; The difficulty of diagnosing leprosy early can increase the chance of transmission and cause deformities secondary to peripheral nerve involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors&#39; contributions</span><p id="par0075" class="elsevierStylePara elsevierViewall">Larissa Daniele Machado G&#243;es&#58; Elaboration and writing of the manuscript&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Juliana Alves Scrignoli&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Patr&#237;cia Morais&#58; Statistical analysis&#59; approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Patr&#237;cia Morais&#58; Statistical analysis&#59; approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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What is your diagnosis?
Case for diagnosis. Infiltrated areas on the trunk
Larissa Daniele Machado Góesa,
Autor para correspondência
larissadaniele55@gmail.com

Corresponding author.
, Juliana Alves Scrignolib, Patrícia Moraisc, Carolina Talharia
a Tropical Dermatology Clinic, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil
b Rheumatology Service, Fundação Hospital Adriano Jorge, Manaus, AM, Brazil
c Dermatopathology Service, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil
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and thickening and pain on palpation of the left ulnar and left external sciatic popliteal nerves&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The bacilloscopy of the ear and two trunk lesions was positive &#40;smear index&#58; 3&#46;33&#41;&#46; Histopathology of the plaque in the inguinal region showed an epidermis with hyperkeratosis&#59; in the dermis&#44; edema and a perivascular&#44; periadnexal&#44; and interstitial mild inflammatory infiltrate composed of lymphocytes&#44; histiocytes&#44; plasmocytes&#44; epithelioid cells&#44; and sparse giant Langhans cells&#44; involving the subcutaneous tissue&#44; adipocytes and septa&#46; Wade staining showed a large number of intracellular acid-fast bacilli&#44; grouped in globi&#44; fragmented and granular &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>A and <a class="elsevierStyleCrossRef" href="#fig0015">3</a> B&#41;&#46; PAS staining did not show thickening of the basal membrane&#44; and no mucin was observed in the Alcian blue staining&#46; 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of the patients with lepromatous leprosy&#59; in 23&#46;6&#37; of those with tuberculoid borderline&#59; in 18&#46;2&#37; of those with borderline forms&#59; and in 16&#46;4&#37; of those with borderline lepromatous type&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Positive ANA can be observed in 3&#37; to 34&#37; of leprosy patients&#46; Titers are generally low&#44; and the speckled and homogeneous patterns are the most common&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Rheumatoid factor&#44; anti-CCP&#44; ANCA&#44; anti-cardiolipin&#44; and antiphospholipids have been observed in varying percentages in patients with the different forms of leprosy&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;8</span></a> Non-scarring alopecia&#44; especially in patients with the lepromatous leprosy&#44; has already been described&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The different clinical manifestations of leprosy pose a diagnostic challenge&#44; since they can mimic other diseases&#44; including autoimmune disorders&#46; The difficulty of diagnosing leprosy early can increase the chance of transmission and cause deformities secondary to peripheral nerve involvement&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Financial support</span><p id="par0070" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Authors&#39; contributions</span><p id="par0075" class="elsevierStylePara elsevierViewall">Larissa Daniele Machado G&#243;es&#58; Elaboration and writing of the manuscript&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Juliana Alves Scrignoli&#58; Approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Patr&#237;cia Morais&#58; Statistical analysis&#59; approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Patr&#237;cia Morais&#58; Statistical analysis&#59; approval of the final version of the manuscript&#59; conception and planning of the study&#59; elaboration and writing of the manuscript&#59; obtaining&#44; analyzing&#44; and interpreting the data&#59; effective participation in research orientation&#59; intellectual participation in propaedeutic and&#47;or therapeutic conduct of studied cases&#59; critical review of the literature&#59; critical review of the manuscript&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0095" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
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2022 Fevereiro 31 42 73
2022 Janeiro 40 84 124
2021 Dezembro 32 56 88
2021 Novembro 30 62 92
2021 Outubro 47 73 120
2021 Setembro 24 42 66
2021 Agosto 35 54 89
2021 Julho 32 45 77
2021 Junho 27 52 79
2021 Maio 47 94 141
2021 Abril 116 215 331
2021 Março 56 70 126
2021 Fevereiro 28 25 53
2021 Janeiro 30 21 51
2020 Dezembro 16 18 34
2020 Novembro 41 13 54
2020 Outubro 21 7 28
2020 Setembro 13 10 23
2020 Agosto 10 8 18
2020 Julho 26 10 36
2020 Junho 3 5 8
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