Exame clínico detalhado como chave para o diagnóstico diferencial entre hanseníase e necrobiose lipoídica: relato de caso

Rafaela Garcia Pereira; Malu de Aquino Almeida Garcia; Natália Senado Alves de Campos; Ana Thais Machado Moutinho; Josie Eiras Bisi dos Santos; Maria Amélia Lopes dos Santos; Elcilane Gomes Silva; Carla Andréa Avelar Pires

doi:10.5712/rbmfc21(48)5065

Authors

Rafaela Garcia Pereira Universidade do Estado do Pará – Belém (PA), Brasil
Malu de Aquino Almeida Garcia Universidade do Estado do Pará – Belém (PA), Brasil
Natália Senado Alves de Campos Universidade do Estado do Pará – Belém (PA), Brasil
Ana Thais Machado Moutinho Universidade do Estado do Pará – Belém (PA), Brasil
Josie Eiras Bisi dos Santos Universidade do Estado do Pará – Belém (PA), Brasil
Maria Amélia Lopes dos Santos Universidade do Estado do Pará – Belém (PA), Brasil
Elcilane Gomes Silva Universidade do Estado do Pará – Belém (PA), Brasil
Carla Andréa Avelar Pires Universidade do Estado do Pará – Belém (PA), Brasil https://orcid.org/0009-0008-6605-186X

DOI:

https://doi.org/10.5712/rbmfc21(48)5065

Keywords:

Leprosy, Necrobiosis lipoidica, Differential diagnosis, Primary Health Care, Physical examination

Abstract

Introduction: Necrobiosis lipoidica is a rare granulomatous dermatosis that may mimic leprosy, especially in endemic countries. Case presentation: We report the case of a 62-year-old woman presenting with pretibial erythematous plaques, without sensory alterations and with an initial histopathological granulomatous pattern. She was treated as tuberculoid leprosy for 12 months, with no clinical improvement. A second biopsy revealed the classical features of necrobiosis lipoidica. Topical corticosteroid therapy was initiated, and the patient remains under outpatient follow-up. Conclusions: This case reinforces the importance of detailed clinical evaluation, particularly sensitivity testing, to avoid unnecessary therapies, adverse effects, and the stigma associated with leprosy. It also highlights the strategic role of Family Physicians in the early differential diagnosis of such conditions.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Hashemi DA, Brown-Joel ZO, Tkachenko E, Nelson CA, Noe MH, Imadojemu S, et al. Clinical features and comorbidities of patients with necrobiosis lipoidica with or without diabetes. JAMA Dermatol. 2019;155(4):455-9. https://doi.org/10.1001/jamadermatol.2018.5635 DOI: https://doi.org/10.1001/jamadermatol.2018.5635

Ionescu AM, Petca A, Dumitrașcu MC, Petca RC, Miron AII, Șandru F. The intersection of dermatological dilemmas and endocrinological complexities: understanding necrobiosis lipoidica–a comprehensive review. Biomedicines. 2024;12(2):337. https://doi.org/10.3390/biomedicines12020337 DOI: https://doi.org/10.3390/biomedicines12020337

Segurado Rodríguez MA, García Donoso C, Gamo Villegas R, Guerra Tapia A, Iglesias Díez L. Necrobiosis lipoídica nodular: a propósito de un caso. Actas Dermosifiliogr. 2002;93(9):555-7. https://doi.org/10.1016/S0001-7310(02)76638-6 DOI: https://doi.org/10.1016/S0001-7310(02)76638-6

Reid SD, Ladizinski B, Lee K, Baibergenova A, Alavi A. Update on necrobiosis lipoidica: a review of etiology, diagnosis, and treatment options. J Am Acad Dermatol. 2013;69(5):783-91. https://doi.org/10.1016/j.jaad.2013.05.034 DOI: https://doi.org/10.1016/j.jaad.2013.05.034

Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Protocolo Clínico e Diretrizes Terapêuticas da Hanseníase [Internet]. Brasília: Ministério da Saúde; 2022 [acessado em 02 out. 2025]. Disponível em: https://www.gov.br/conitec/pt-br/midias/protocolos/publicacoes_ms/copy_of_20230131_PCDT_Hanseniase_2022_eletronica_ISBN.pdf

Soares CT. Histopathological diagnosis of leprosy. Sharjah: Bentham Science Publishers; 2021. https://doi.org/10.2174/97816810879931210101 DOI: https://doi.org/10.2174/97816810879931210101

Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Boletim Epidemiológico Hanseníase 2023 [Internet]. Brasília: Ministério da Saúde; 2023 [acessado em 04 out. 2025]. Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/epidemiologicos/especiais/2023/boletim_hanseniase-2023_internet_completo.pdf/view

Deeks JJ, Altman DG. Diagnostic tests 4: likelihood ratios. BMJ. 2004;329(7458):168-9. https://doi.org/10.1136/bmj.329.7458.168 DOI: https://doi.org/10.1136/bmj.329.7458.168

Bender LL, Cezar GVA, Souza DM, Gouveia LC, Gouveia NM. Necrobiose lipoídica: uma revisão bibliográfica atualizada. Rev Saúde Multidisciplinar. 2024;16(1):52-8. https://doi.org/10.53740/rsm.v16i1.760 DOI: https://doi.org/10.53740/rsm.v16i1.760

Mehrotra P, Tirumalae R. Necrobiosis lipoidica through the microscope. J Dermatol Dermatol Surg. 2024;28(2):100-4. https://doi.org/10.4103/jdds.jdds_34_24 DOI: https://doi.org/10.4103/jdds.jdds_34_24

Verheyden P, Rodrigo N, Gill AJ, Glastras SJ. A case series and literature review of necrobiosis lipoidica. Endocrinol Diabetes Metab Case Rep. 2022:2022:21-0185. https://doi.org/10.1530/EDM-21-0185 DOI: https://doi.org/10.1530/EDM-21-0185

Marcoval J, Gómez-Armayones S, Valentí-Medina F, Bonfill-Ortí M, Martínez-Molina L. Necrobiosis lipoidica: a descriptive study of 35 cases. Actas Dermosifiliogr. 2015;106(5):402-7. https://doi.org/10.1016/j.ad.2015.01.004 DOI: https://doi.org/10.1016/j.adengl.2015.04.008