<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2072-8174</journal-id>
<journal-title><![CDATA[Revista del Nacional (Itauguá)]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. Nac. (Itauguá)]]></abbrev-journal-title>
<issn>2072-8174</issn>
<publisher>
<publisher-name><![CDATA[Hospital Nacional (Itauguá)]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2072-81742020000200107</article-id>
<article-id pub-id-type="doi">10.18004/rdn2020.dic.02.107.115</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Eritema nodoso necrosante en lepra lepromatosa asociada a infección mixta por Mycobacterium lepromatosis y Mycobacterium leprae]]></article-title>
<article-title xml:lang="en"><![CDATA[Necrotizing erythema nodosumin lepromatous leprosy associated with mixed infection by Mycobacterium lepromatosis and Mycobacterium leprae]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Aldama Olmedo]]></surname>
<given-names><![CDATA[Olga María]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Escobar]]></surname>
<given-names><![CDATA[Marcial]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Martínez]]></surname>
<given-names><![CDATA[María Julia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Aldama]]></surname>
<given-names><![CDATA[Monserrat]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Montoya Bueno]]></surname>
<given-names><![CDATA[Camila]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Celias]]></surname>
<given-names><![CDATA[Luis Fabian]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Hernandez-Castro]]></surname>
<given-names><![CDATA[Rigoberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Arenas-Guzmán]]></surname>
<given-names><![CDATA[Roberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Pereira Brunelli]]></surname>
<given-names><![CDATA[José]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Ministerio de Salud Pública y Bienestar Social Programa Nacional de Control de la Lepra Centro de Especialidades Dermatológicas]]></institution>
<addr-line><![CDATA[San Lorenzo ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Ministerio de Salud Pública y Bienestar Social Dirección de Anatomía Patológica ]]></institution>
<addr-line><![CDATA[Asunción ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Secretaria de Salud Hospital General Dr. Manuel Gea González Sección de Micología]]></institution>
<addr-line><![CDATA[Ciudad de México, CDMX ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>12</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>12</month>
<year>2020</year>
</pub-date>
<volume>12</volume>
<numero>2</numero>
<fpage>107</fpage>
<lpage>115</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S2072-81742020000200107&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S2072-81742020000200107&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S2072-81742020000200107&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN La lepra es una enfermedad causada por Mycobacterium leprae. Su evolución crónica a veces se ve interrumpida por cuadros inmunológicos llamados reacción leprosa en pacientes con alta carga bacilar. Estos cuadros inmunológicos incrementan la morbilidad y pueden complicarse, volviéndose potencialmente mortales. En el espectro de estas reacciones, se han descrito algunas caracterizadas por lesiones vasculo necróticas, como el Fenómeno de Lucio y el eritema nodoso lepromatoso necrosante, que son asociadas a la lepra lepromatosa difusa y a la especie de bacilos recién descripta, Mycobacterium lepromatosis. Presentamos un paciente de sexo femenino de 21 años de edad, que durante el tratamiento específico para lepra multibacilar presentó cuadros recidivantes de eritema nudoso que evolucionó a la forma necrosante. En este paciente se precisó a través de la biología molecular la presencia simultánea de M. leprae y M. lepromatosis como causantes de la enfermedad. Este caso representa la primera comunicación de M. lepromatosis en el Paraguay, y también la primera infección dual como agente causante de lepra, en asociación con el M. leprae.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT Leprosy is a disease caused by Mycobacterium leprae. Its chronic evolution is sometimes interrupted by immunological conditions called leprosy reaction in patients with high bacillary load. These immunological conditions increase morbidity and can be complicated, becoming life threatening. In the spectrum of these reactions, some characterized by vasculonecrotic lesions have been described, such as Lucio's Phenomenon and Necrotizing Lepromatous Nodus Erythem, which are associated with diffuse lepromatous leprosy and the species of bacilli just described, Mycobacterium lepromatosis. We present a 21-year-old female patient, who during specific treatment for multibacillary leprosy presented recurrent pictures of erythema nodosum that evolved to the necrotizing form. In this patient, the simultaneous presence of M. leprae and M. lepromatosis as the cause of the disease was determined through molecular biology. This case represents the first communication of M. lepromatosis in Paraguay, and also the first dual infection as a causative agent of leprosy, in association with M. leprae.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Mycobacterium lepromatosis]]></kwd>
<kwd lng="es"><![CDATA[eritema nudoso]]></kwd>
<kwd lng="es"><![CDATA[lepra]]></kwd>
<kwd lng="es"><![CDATA[Paraguay]]></kwd>
<kwd lng="en"><![CDATA[Mycobacterium lepromatosis]]></kwd>
<kwd lng="en"><![CDATA[erythema nodosum]]></kwd>
<kwd lng="en"><![CDATA[leprosy]]></kwd>
<kwd lng="en"><![CDATA[Paraguay]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Han]]></surname>
<given-names><![CDATA[XY]]></given-names>
</name>
<name>
<surname><![CDATA[Jessurun]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Severeleprosy reactions due to Mycobacterium lepromatosis]]></article-title>
<source><![CDATA[Am J Med Sci]]></source>
<year>2013</year>
<volume>345</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>65-9</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Scollard]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Infection with Mycobacterium lepromatosis]]></article-title>
<source><![CDATA[Am J Trop Med Hyg]]></source>
<year>2016</year>
<volume>95</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>500-1</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<collab>World Health Organization</collab>
<article-title xml:lang=""><![CDATA[Global leprosy update, 2018: moving towards a leprosy-free world.]]></article-title>
<source><![CDATA[Weekly epidemiological record]]></source>
<year>2019</year>
<volume>94</volume>
<numero>35/36</numero>
<issue>35/36</issue>
<page-range>389-412</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Dhillon]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Sharma]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Sing]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Tandon]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Sarin]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Khan]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Erythema necroticans a rare reaction pattern in leprosy.]]></article-title>
<source><![CDATA[Ind J Adv Med]]></source>
<year>2015</year>
<volume>2</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>185-7</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Aldama]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Rivelli]]></surname>
<given-names><![CDATA[V]]></given-names>
</name>
<name>
<surname><![CDATA[Aldama]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[Ozekoski]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Gorostiaga]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Lepra hoy consideraciones epidemiológicas del Hospital Nacional.]]></article-title>
<source><![CDATA[Rev. Nac. (Itauguá).]]></source>
<year>2009</year>
<volume>1</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>27-30</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mohanty]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Naaz]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Bansal]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Kumar]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Sharma]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Arora]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Molecular detection of Mycobacterium leprae using RLEP-PCR in ´post elimination of leprosy]]></article-title>
<source><![CDATA[Mol Biol Res Commun]]></source>
<year>2020</year>
<volume>9</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>17-22</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Widiatma]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Sukanto]]></surname>
<given-names><![CDATA[H]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Difusse lepromatous leprosy caused by dual infection of Mycobacterium leprae and Mycobacterium lepromatosis A case report]]></article-title>
<source><![CDATA[DermatologyReports]]></source>
<year>2019</year>
<volume>11</volume>
<numero>s1</numero>
<issue>s1</issue>
<page-range>8094</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Hoyos Gómez]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Cardona Castri]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Reacciones leprosas]]></article-title>
<source><![CDATA[Rev CES Med]]></source>
<year>2016</year>
<volume>30</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>200-9</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Lezcano]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Di Martino]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Galeano]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Aldama]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Rodríguez]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Knopfelmacher]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Reacciones vasculonecróticas en lepra Descripción de dos casos de fenómeno de Lucio]]></article-title>
<source><![CDATA[Med Cutan Iber Lat Am]]></source>
<year>2010</year>
<volume>38</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>161-3</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Riveros]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Contreras]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Galeano]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Di Martino]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Rodríguez]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Bolla]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Reacciones leprosas simulamdo vasculitis cutánea Reporte de 3 casos y revisión de la literatura.]]></article-title>
<source><![CDATA[Rev. Par. Reumatol.]]></source>
<year>2019</year>
<volume>5</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>33-8</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Han]]></surname>
<given-names><![CDATA[XY]]></given-names>
</name>
<name>
<surname><![CDATA[Aung]]></surname>
<given-names><![CDATA[FM]]></given-names>
</name>
<name>
<surname><![CDATA[Choon]]></surname>
<given-names><![CDATA[SE]]></given-names>
</name>
<name>
<surname><![CDATA[Werner]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Análisis de los agentes de lepra Mycobacterium leprae y Mycobacterium lepromatosis en cuatro países]]></article-title>
<source><![CDATA[Soy J ClinPathol]]></source>
<year>2014</year>
<volume>142</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>524-32</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Singh]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Benjak]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Schuenemann]]></surname>
<given-names><![CDATA[VJ]]></given-names>
</name>
<name>
<surname><![CDATA[Herbig]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Avanzi]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Busso]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Insightinto the evolution and origin of leprosybacilli from the genomesequenceof Mycobacterium lepromatosis]]></article-title>
<source><![CDATA[PNAS]]></source>
<year>2015</year>
<volume>112</volume>
<numero>14</numero>
<issue>14</issue>
<page-range>4459-64</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Samudio]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Espínola]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Reacciones lepromatosas en pacientes adultos y pediátricos en un centro de referencia Programa Nacional de Lepra, Paraguay]]></article-title>
<source><![CDATA[Rev. Nac. (Itauguá).]]></source>
<year>2016</year>
<volume>8</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>4-18</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>15</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Trave]]></surname>
<given-names><![CDATA[I]]></given-names>
</name>
<name>
<surname><![CDATA[Barabino]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Cavalchini]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Parodi]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Long-term ulcerations caused by Mycobacterium lepromatosis]]></article-title>
<source><![CDATA[Int J Mycobacteriol]]></source>
<year>2020</year>
<volume>9</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>223-5</page-range></nlm-citation>
</ref>
<ref id="B15">
<label>16</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Negera]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
<name>
<surname><![CDATA[Walker]]></surname>
<given-names><![CDATA[SL]]></given-names>
</name>
<name>
<surname><![CDATA[Girma]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Doni]]></surname>
<given-names><![CDATA[SN]]></given-names>
</name>
<name>
<surname><![CDATA[Tsegaye]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Lambert]]></surname>
<given-names><![CDATA[SM]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Clinico-pathological feactures of erythema nodosum leprosum A case-control study at ALERT hospital, Ethiopia]]></article-title>
<source><![CDATA[PLoS Negl Trop Dis]]></source>
<year>2017</year>
<volume>11</volume>
<numero>10</numero>
<issue>10</issue>
<page-range>1-11</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
