Rahil Ali Ibrahim, Osman Ahmed, Magdi Mohamed, Kanbour Sara, Mahfouz Ahmed Emad
Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.
Weill Cornell Medical College, Doha, Qatar.
Eur J Case Rep Intern Med. 2020 Jan 20;7(2):001302. doi: 10.12890/2020_001302. eCollection 2020.
Thrombotic disease represents a rare manifestation of leprosy. In this study, we report the case of an external jugular vein thrombosis associated with tuberculoid leprosy in a 23-year-old male patient. The patient presented with a 3-month history of painful cord-like swelling on the left side of the neck and a nearly 3-week history of skin lesions on the left cheek and right leg. Physical examination revealed cord-like, tender swelling on the left lateral aspect of the neck overlying the sternocleidomastoid muscle, and a hypopigmented, hypoaesthetic 6×7 cm lesion with an irregular margin on the left cheek. A Doppler ultrasound examination of the jugular vein showed thrombosis of the left external jugular vein. Three-dimensional reconstruction of the computed tomography scan showed the enlarged and enhanced left external jugular vein, as well as 1 of its tributaries, and the thickened skin patch. A skin punch biopsy from the left cheek lesion revealed granulomatous inflammation with occasional peri-adnexal granulomas, consistent with the clinical impression of tuberculoid leprosy. A diagnosis of leprosy with external jugular vein thrombosis was established. Anticoagulation therapy was initiated, and the patient was referred to an infectious disease clinic for treatment with anti-leprosy medications.
Thickened cord-like neck swelling in leprosy can be vein thrombosis rather than a thickened nerve.Leprosy should be considered if a skin lesion is associated with thrombosis.The common causes of upper extremity DVT.
血栓形成性疾病是麻风的一种罕见表现。在本研究中，我们报告了一名23岁男性患者，其患有与结核样型麻风相关的颈外静脉血栓形成。患者有左侧颈部疼痛性条索状肿胀3个月的病史，左侧脸颊和右腿皮肤病变近3周的病史。体格检查发现，在胸锁乳突肌上方的左侧颈部外侧有条索状、压痛性肿胀，左侧脸颊有一个6×7 cm的色素减退、感觉减退的病变，边缘不规则。对颈静脉进行多普勒超声检查显示左侧颈外静脉血栓形成。计算机断层扫描的三维重建显示左侧颈外静脉及其一条分支增粗且强化，以及增厚的皮肤斑块。对左侧脸颊病变进行皮肤打孔活检显示肉芽肿性炎症，偶见附件周围肉芽肿，与结核样型麻风的临床印象一致。确诊为麻风伴颈外静脉血栓形成。开始抗凝治疗，并将患者转诊至传染病诊所接受抗麻风药物治疗。
麻风患者颈部出现增粗的条索状肿胀可能是静脉血栓形成而非神经增粗。如果皮肤病变与血栓形成相关，应考虑麻风。上肢深静脉血栓形成的常见原因。
