An uncommon variant of erythema nodosum leprosum responding well to methotrexate: Report of two cases

2021 ◽  
pp. 004947552110166
Author(s):  
Seema Rani ◽  
Sweta Singh ◽  
Diksha Agrawal ◽  
Kabir Sardana ◽  
Arvind Ahuja
Keyword(s):  
Low Dose ◽  
Erythema Nodosum ◽  
Type I ◽  
Type Ii ◽  
Permanent Disability ◽  
Atypical Features ◽  
Erythema Nodosum Leprosum

Reactions in leprosy are acute inflammatory episodes that can be classified as type I or type II. Recognition and timely management of these patients is critical to avoid permanent disability. We present two cases of erythema nodosum leprosum, presenting with recurrent atypical features, responding well to a low dose of methotrexate.

Methotrexate in erythema nodosum leprosum: Pitfalls to avoid

2021 ◽  
pp. 004947552110561
Author(s):  
Hitaishi Mehta ◽  
Tarun Narang ◽  
Sunil Dogra ◽  
Bhushan Kumar
Keyword(s):  
Low Dose ◽  
Erythema Nodosum ◽  
Short Report ◽  
Dose Methotrexate ◽  
Atypical Features ◽  
Erythema Nodosum Leprosum

We read with interest the short report by Rani et al. entitled “An uncommon variant of erythema nodosum leprosum responding well to methotrexate: Report of two cases.” The article describes two cases of erythema nodosum leprosum (ENL) with ‘atypical features’ and good response to low dose methotrexate. The authors address a few concerns regarding methotrexate in ENL, emphasizing the rational usage of this agent.

Case Report: Rapid Response to Low-Dose Thalidomide in a Case of Severe Steroid Recalcitrant Erythema Nodosum Leprosum

2021 ◽  
Author(s):  
B. Savitha ◽  
Kabir Sardana ◽  
Ritu Kumari ◽  
Ananta Khurana ◽  
Surabhi Sinha ◽  
...  
Keyword(s):  
Low Dose ◽  
Erythema Nodosum ◽  
Lepromatous Leprosy ◽  
High Dose ◽  
Effective Treatment Option ◽  
Steroid Dependence ◽  
Erythema Nodosum Leprosum ◽  
Organ Specific ◽  
Inflammatory Drugs

Erythema nodosum leprosum (ENL), or type 2 lepra reaction, presents with crops of evanescent, tender erythematous nodules accompanied by fever, arthralgia, weight loss, malaise, and organ-specific manifestations, and is seen in borderline and lepromatous leprosy. The drugs approved for ENL include nonsteroidal anti-inflammatory drugs, systemic steroids, thalidomide, and clofazimine. The management of ENL is challenging because long-term steroid use leads to steroid dependence. Our patient had severe steroid recalcitrant ENL with vesicular and pustular lesions mimicking Sweet’s syndrome, and was treated effectively with a low-dose thalidomide regimen (100 mg/d) as opposed to the high dose (400 mg/d) recommended in the literature. We discuss the patho-mechanics and clinical utility of a low-dose thalidomide regimen as an effective treatment option for ENL.

Importance of brain IL-1 type II receptors in fever and thermogenesis in the rat

1993 ◽  
Vol 265 (4) ◽  
pp. E585-E591 ◽  
Author(s):  
G. Luheshi ◽  
S. J. Hopkins ◽  
R. A. Lefeuvre ◽  
M. J. Dascombe ◽  
P. Ghiara ◽  
...  
Keyword(s):  
Monoclonal Antibody ◽  
Low Dose ◽  
Interleukin 1 ◽  
Type I ◽  
Intracerebroventricular Injection ◽  
Type Ii ◽  
Central Effects ◽  
Conscious Rats ◽  
Central Actions ◽  
The Brain

Interleukin-1 (IL-1) acts centrally to induce fever and thermogenesis in rodents. The central actions of IL-1 alpha and IL-1 beta apparently involve different mechanisms, and the effects of IL-1 beta are not consistent with interaction with a type I (IL-1RI) 80-kDa receptor. In the present study the involvement of the type II IL-1 receptor (IL-1RII) was tested in the rat by examining the effects of central injection of a monoclonal antibody (ALVA-42), which blocks the IL-1RII. Pretreatment of rats with ALVA-42 (6 micrograms icv) inhibited the thermogenic and pyrogenic responses to intracerebroventricular injection of 5 ng (but not 50 ng) of IL-1 beta in conscious rats but did not significantly modify responses to IL-1 alpha. ALVA-42 also failed to modify the responses to peripherally administered IL-1 beta (1 microgram) but significantly attenuated the pyrogenic and thermogenic responses to peripheral (125 micrograms) or central (1 microgram) injection of endotoxin. These data indicate that IL-1RII mediates the central effects of a low dose of IL-1 beta, but not IL-1 alpha, on fever and thermogenesis in the rat. They also imply that responses to endotoxin are due, at least in part, to the activation of IL-1RII by IL-1 beta released within the brain and that effects of peripherally injected IL-1 beta involve different mechanisms, probably associated with IL-1RI.

scholarly journals Host-Related Laboratory Parameters for Leprosy Reactions

2021 ◽  
Vol 8 ◽  
Author(s):  
Yuqian Luo ◽  
Mitsuo Kiriya ◽  
Kazunari Tanigawa ◽  
Akira Kawashima ◽  
Yasuhiro Nakamura ◽  
...  
Keyword(s):  
Erythema Nodosum ◽  
Clinical Symptoms ◽  
Type I ◽  
Leprosy Reactions ◽  
Erythema Nodosum Leprosum ◽  
Precise Diagnosis ◽  
Reversal Reaction

Leprosy reactions are acute inflammatory episodes that complicate the course of a Mycobacterium leprae infection and are the major cause of leprosy-associated pathology. Two types of leprosy reactions with relatively distinct pathogenesis and clinical features can occur: type 1 reaction, also known as reversal reaction, and type 2 reaction, also known as erythema nodosum leprosum. These acute nerve-destructive immune exacerbations often cause irreversible disabilities and deformities, especially when diagnosis is delayed. However, there is no diagnostic test to detect or predict leprosy reactions before the onset of clinical symptoms. Identification of biomarkers for leprosy reactions, which impede the development of symptoms or correlate with early-onset, will allow precise diagnosis and timely interventions to greatly improve the patients' quality of life. Here, we review the progress of research aimed at identifying biomarkers for leprosy reactions, including its correlation with not only immunity but also genetics, transcripts, and metabolites, providing an understanding of the immune dysfunction and inflammation that underly the pathogenesis of leprosy reactions. Nevertheless, no biomarkers that can reliably predict the subsequent occurrence of leprosy reactions from non-reactional patients and distinguish type I reaction from type II have yet been found.

scholarly journals 812. Case–Control Trial to Evaluate the Cytokine Response to the Use of Capsule Thalidomide in Erythema Nodosum Leprosum in Leprosy Patients

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S290-S291
Author(s):  
Ajay Chopra ◽  
Debdeep Mitra ◽  
Barnali Mitra
Keyword(s):  
Immune Response ◽  
Erythema Nodosum ◽  
Skin Lesions ◽  
Interferon Γ ◽  
Controlled Study ◽  
Type Ii ◽  
Drug Of Choice ◽  
Erythema Nodosum Leprosum ◽  
Tnf Α ◽  
Systemic Symptoms

Abstract Background Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. Type II lepra reaction or Erythema Nodosum Leposum is a Type III hypersentivity immune response during the chronic course of the illness. This immune response presents as systemic symptoms and neutrophilic leukocytosis, similar to sepsis. Capsule Thalidomide is considered the drug of choice, when it comes to the treatment of this acute immunological emergency. A rational study into the immunological markers involved in the pathogenesis of erythema nododsum leprosum and its successful suppression by Thalidomide should be helpful in early diagnosis and prompt successful therapy. On the basis of previous studies, our aim was to find a correlation with interferon-γ, tumour necrosis factor-α, and Cd-64 expression on activated circulating neutrophils during Type II lepra reaction and successful response to capsule Thalidomide. Methods This case-controlled study included one group of patients diagnosed to have leprosy and the other group was healthy controlled individuals with matched age, sex, and area of residence. All the patients with type II lepra reaction responded to Capsule Thalidomide clinically, and all the skin lesions resolved in 7–14 days. Blood samples and skin biopsy were subjected to histopathology, immunoflourescence assay, immunohistochemical staining, quantitative RT-PCR (reverse transcriptase-polymerase chain reaction), and flow cytometry. Results Interferon-γ and TNF-α are sensitive markers in diagnosing erythema nodosum leprosum and Cd-64 expression on activated circulating neutrophils is both a specific and sensitive marker in Type II lepra reaction. Cd-64 expression also had a positive correlation with Thalidomide treatment and clinical response. High polymorphonuclear Cd-64 expression was correlated with severity of ENL. Conclusion Cd-64 expression on circulating neutrophils is a potential early biophysical marker for diagnosing erythema nodosum leprosum and can be used as a tool to assess thalidomide response. It is however not a good index to diagnose leprosy infection as it was specific for Type II lepra reaction. Interferon-γ and TNF-α are sensitive markers to screen for lepra reactions and this study showed no significant correlation with Thalidomide therapy. Disclosures All authors: No reported disclosures.

scholarly journals Type II reaction without erythema nodosum leprosum masquerading as lymphoma

2012 ◽  
Vol 83 (4) ◽  
pp. 378-383
Author(s):  
Rahul Mahajan ◽  
Sunil Dogra ◽  
Inderjeet Kaur ◽  
Savita Yadav ◽  
Uma Nahar Saikia ◽  
...  
Keyword(s):  
Erythema Nodosum ◽  
Type Ii ◽  
Erythema Nodosum Leprosum

scholarly journals 1345. Randomized Control Trial to Evaluate the Clinical and Cytokine Response Profile to Oral Thalidomide in Leprosy Patients with Erythema Nodosum Leprosum

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S487-S487
Author(s):  
Ajay Chopra ◽  
Debdeep Mitra
Keyword(s):  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Erythema Nodosum ◽  
Venous Blood ◽  
Disease Process ◽  
Type Ii ◽  
Blood Samples ◽  
Erythema Nodosum Leprosum ◽  
Randomized Control ◽  
Necrosis Factor

Abstract Background Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. Erythema Nodosum Leprosum is an acute inflammatory Type III hypersensitivity response during the chronic course of the disease process. This immune response manifests clinically as painful red nodules and systemic symptoms similar to sepsis with neutrophilic leukocytosis. Capsule Thalidomide is the drug of choice for treating this condition. Methods A randomized control study to study the immunological markers involved in the pathogenesis of erythema nododsum leprosum and its successful suppression by Thalidomide should provide newer insight into the pathogenesis of this disease process, provide better diagnostic and therapeutic options and better markers to predict prognosis. Based on the previous studies our aim was to find a correlation with tumor necrosis factor-a, interferon-gamma, and Cd-64 expression on activated circulating neutrophils during Type II lepra reaction and the successful response to capsule Thalidomide. Venous blood samples were collected from all the samples and after 7 days post thalidomide therapy, only in the treated population. All the patients with type II lepra reaction responded to Capsule Thalidomide clinically and all the skin lesions resolved in 7–14 days. Blood samples and skin biopsy was subjected to histopathology, immunofluorescence assay, immunohistochemical staining, quantitative RT–PCR (reverse transcriptase-polymerase chain reaction) and flow cytometry. Results Study found out that Interferon Γand Tumor necrosis factor-Α are sensitive markers in diagnosing erythema nodosum leprosum and Cd-64 expression on activated circulating neutrophils is both a specific and sensitive marker. Cd-64 expression also had a positive correlation with Thalidomide treatment and clinical response. Conclusion Cd-64 expression on circulating neutrophils is a potential early biophysical marker for diagnosing erythema nodosum leprosum and can be used as a tool to assess thalidomide response. InterferonΓ and Tumor necrosis factorΑ are sensitive markers to screen for lepra reactions and this study showed no significant correlation with Thalidomide therapy. Disclosures All authors: No reported disclosures.

scholarly journals α 1-Acid glycoprotein as a putative biomarkerfor monitoring the development of the type II reactional stage of leprosy

2010 ◽  
Vol 59 (4) ◽  
pp. 400-407 ◽  
Author(s):  
Nishma Gupta ◽  
Nallakandy P. Shankernarayan ◽  
Kuppamuthu Dharmalingam
Keyword(s):  
Immune Responses ◽  
Differential Expression ◽  
Neurological Complications ◽  
Disease Stage ◽  
Type I ◽  
Type Ii ◽  
Efficient Treatment ◽  
Acid Glycoprotein ◽  
Host Immune Responses ◽  
Erythema Nodosum Leprosum

Leprosy, a spectral disease manifested on the basis of host immune responses,is complicated by its reactional stages, namely type I reversal reaction (RR)and type II erythema nodosum leprosum (ENL). These reactional stagesare characterized by uncontrolled and aberrant immune responses. Biomarkersfor reactional stages would aid in early diagnosis, efficient treatment, preventionof neurological complications and prediction of predisposition to reactionalstages. In this study, comparative analysis of the serum proteome of leprosypatients by two-dimensional electrophoresis (2DE) followed by massspectrometry showed differential expression of acute-phase protein α 1-acid glycoprotein (AGP; also known as orosomucoid).AGP levels in untreated ENL cases were significantly higher than in lepromatousleprosy (LL; a non-reactional disease stage) (P=0.0126),RR (P=0.0176) and healthy controls (P=0.0030).These data were confirmed using ELISA. The levels of AGP decreased to normallevels after treatment with multidrug therapy and thalidomide (P=0.0167). In a follow-up study, AGP levels, which were highin the untreated ENL stage, decreased significantly at 5 days (P=0.0084) and 21 days (P=0.0027)post-treatment. A stage-dependent increase in AGP in an LL patient who progressedinto the ENL stage was also shown. Glycosylation analysis by 2DE showed differentialexpression of acidic glycoforms of AGP in untreated ENL cases. Changes inAGP concentration and differential expression of isoforms correlated withthe inflammatory condition in ENL and also with the treatment regimen. Thus,initial validation of AGP as an ENL-specific biomarker and treatment indicatorwas shown in this study.

Sign in / Sign up

Export Citation Format

Share Document