The nose in leprosy: Immunohistology of the nasal mucosal

A detailed study of the nose was undertaken in 40 leprosy patients with dif ferent classifications of leprosy and different durations of disease at two hospitals in Brazil. This manuscript describes the immunohistochemical dat a on cellular infiltrates in the nasal biopsies of those patients. It was s urprising that the damage to the whole depth of the nasal mucosa, epitheliu m and lamina propria was considerable, as was the case in the nasal mucosa which looked relatively normal during clinical inspection. The epithelium s howed large holes which looked like very extended goblet cells. Very obviou s was the lack of vasoconstriction after cocaine application, and the vesse ls also showed a lack of staining with factor VIII, possibly indicating a d isruption of the endothelium. The number of neurofilaments was extensively reduced in all leprosy groups compared to normal controls. As in the skin, an increased number of CD68+ cells was found in the lamina propria of the n asal mucosa of the lepromatous patients. Contrary to findings in the skin, in the nasal mucosa of the borderline/lepromatous patients the number of CD 4+ cells was increased and the number of CD8+ cells was decreased compared to normal controls. The number of CD8+ cells tended to be more reduced when the history of leprosy was longer. It is not clear as yet whether the redu ced numbers of CD8+ cells are acquired during infection or whether persons with a low number of CD8+ cells in the nose might have a higher risk of acq uiring leprosy.