Download Hertoghe sign: an hallmark of lepromatous leprosy

QJM Advance Access published March 29, 2016
Hertoghe sign: an hallmark of lepromatous leprosy
Daniela Parrino and Stefano Di Bella
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Daniela Parrino, M.D. - University of Milano-Bicocca, via Cadore 48 – 20900, Monza, Italy.
Phone: +393381739699; email: [email protected]
•
Stefano Di Bella, M.D. - Infectious Disease Unit, University Hospital of Trieste, Trieste, Italy.
Phone: +393290135511; email: [email protected]
Piazzale Ospitale 1, 34100, Trieste, Italy. Tel.: +39 040 399 2591. Fax: +39 040 399 2652. Email:
[email protected]
© The Author 2016. Published by Oxford University Press on behalf of the Association of Physicians.
All rights reserved. For Permissions, please email: [email protected]
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Corresponding author: Stefano Di Bella - Infectious Disease Unit, University Hospital of Trieste,
A 56-year-old Italian man presented with diffuse erythematous lesions on his face and bilateral
Hertoghe sign (Figure 1). He reported numbness of his hands and feet. He had been prisoner in
Venezuela for 25 years. Physical examination revealed similar lesions on his chest, arms, feet,
knees and scrotum. Hypoesthesia and anhidrosis were noticed on the affected areas. He underwent
cutaneous biopsy that demonstrated perineural invasion by acid-fast bacilli, thus confirming the
suspicion of leprosy (culture for mycobacteria and polymerase chain reaction for M. tuberculosis
were negative). Ophthalmologic investigation did not reveal further eye lesions. He was
recommended multi-drug therapy and, and a strict follow-up aimed at preventing disability.
Hertoghe sign, also known as Queen Anne’s sign, is the thinning or loss of the outer third of the
eyebrows (1, 2). Eyebrow madarosis was reported in 76% of patients with multibacillary leprosy (3,
highest incidence of ocular involvement of any human bacterial infection (5). In India, where
leprosy is largely diffused, madarosis has become pathognomonic of the infection (4). Its absence is
a good prognostic sign in long-standing cases (4). When eyes are involved some patients can have
ongoing eye problems despite the completion of chemotherapy (5). Hertoghe sign can also be
detected in hypothyroidism, syphilis and dermatologic conditions (2, 4), but its detection in patients
with diagnosis of leprosy could indicate the presence of additional eye lesions, and should prompt
careful ophthalmologic investigation aimed at revealing and preventing it.
Funding: none
References
1.
Popovici D, Hertoghe J. Cardiothyreosis. Endocrinologie. 1991;29:119-36.
2.
Kumar KV, Prusty P. Visual vignette. The Hertoghe sign. Endocr Pract. 2011;17:666.
3.
Soshamma G, Suryawanshi N. Eye lesions in leprosy. Lepr Rev. 1989;60:33-8.
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4). It is due to histiocytic infiltration of hair follicles with subsequent atrophy (4). Leprosy has the
4.
Kumar A, Karthikeyan K. Madarosis: a marker of many maladies. Int J Trichology.
2012;4:3-18.
5.
Grzybowski A, Nita M, Virmond M. Ocular leprosy. Clin Dermatol. 2015;33:79-89.
Figure Legend
Figure 1: Loss of the outer third of the eyebrow
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Figure: Loss of the outer third of the eyebrow
163x219mm (300 x 300 DPI)