Cutaneous ulceration as a presenting feature of type 1 lepra reaction: A case report

2022 ◽  
pp. 004947552110686
Author(s):  
Pallavi Hegde ◽  
Deepti Jaiswal ◽  
Varsha M Shetty ◽  
Kanthilatha Pai ◽  
Raghavendra Rao

Reactions in leprosy represent sudden shift in the immunological response and are seen in 11–25% of affected patients. It can be seen before, during or after the completion of multidrug therapy (MDT). 1 Two types of reactions are recognized; Type 1 reaction (T1R), seen in borderline leprosy, affecting mainly skin and nerves; type 2 reaction (T2R) or erythema nodosum leprosum (ENL), seen in lepromatous leprosy, characterized by systemic features in addition to cutaneous lesions. Trophic ulcers and ulcerating ENL are well known entities while cutaneous ulceration in T1R is extremely rare; we describe an immune-competent woman with cutaneous ulceration as a presenting feature to highlight the need to recognize this entity at the earliest opportunity.

2021 ◽  
pp. 004947552199849
Author(s):  
Prakriti Shukla ◽  
Kiran Preet Malhotra ◽  
Parul Verma ◽  
Swastika Suvirya ◽  
Abir Saraswat ◽  
...  

Non-neuropathic ulcers in leprosy patients are infrequently seen, and atypical presentations are prone to misdiagnosis. We evaluated diagnosed cases of leprosy between January 2017 and January 2020 for the presence of cutaneous ulceration, Ridley–Jopling subtype of leprosy, reactions and histologic features of these ulcerations. Treatment was given as WHO recommended multi-bacillary multi-drug therapy. We found 17/386 leprosy patients with non-neuropathic ulcers. We describe three causes – spontaneous cutaneous ulceration in lepromatous leprosy (one nodular and one diffuse), lepra reactions (five patients with type 1; nine with type 2, further categorised into ulcerated Sweet syndrome-like who also had pseudoepitheliomatous hyperplasia, pustulo-necrotic and necrotic erythema nodosum leprosum) and Lucio phenomenon (one patient). Our series draws attention towards the different faces of non-neuropathic ulcers in leprosy, including some atypical and novel presentations.


2010 ◽  
Vol 14 (2) ◽  
pp. 95-99 ◽  
Author(s):  
Mélissa Saber ◽  
Caroline Bourassa-Fulop ◽  
Danielle Bouffard ◽  
Nathalie Provost

Background: Erythema nodosum leprosum (ENL) is a disease rarely encountered in Canada. It is characterized by multiple remissions and recurrences, often requires long-term treatment, and can result in debilitating sequelae. Objective: To promote rapid recognition and adequate therapy for ENL. Methods: Case report of a 39-year-old man diagnosed with an ENL. The clinical and histopathologic features, treatment provided, and response to treatment are detailed in this article. Results: ENL presented itself as painful cutaneous lesions on the face and limbs, bilateral paresthesia of the fourth and fifth fingers, and systemic symptoms. Prednisone 40 mg daily for a week and then 60 mg daily for another week reduced the lesions by 80% and the pain by 50%. Although prednisone 60 mg daily was continued for one more week and then stopped, thalidomide was started at a dose of 300 mg daily for 4 weeks and then reduced gradually, which led to complete resolution. Conclusion: At the 7½-month follow-up, the patient remained completely asymptomatic.


Author(s):  
Navdeep Kaur

A 54 years old male, presented with acute onset of fever, malaise and body ache and multiple painful reddish swellings and fluid filled lesions in different parts of body. He gave history suggestive of several earlier episodes of type 2 lepra reactions with erythema nodosum leprosum lesions which were managed with corticosteroids. Dermatological examination revealed multiple erythematous tender nodules and plaques on face, extremities and trunk. He also had multiple bullous lesions on trunk. Investigations revealed polymorphonuclear leukocytosis and raised ESR. Biochemical investigations were normal. Slit skin smear examination showed fragmented acid fast bacilli with bacteriological index of 5+.


2021 ◽  
Vol 8 ◽  
Author(s):  
Yuqian Luo ◽  
Mitsuo Kiriya ◽  
Kazunari Tanigawa ◽  
Akira Kawashima ◽  
Yasuhiro Nakamura ◽  
...  

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.


Author(s):  
Urvi H. Shah ◽  
Monal M. Jadwani ◽  
Sahana P. Raju ◽  
Pranav H. Ladani ◽  
Neela V. Bhuptani

<p class="abstract"><strong>Background:</strong> Lepra reactions remain a major persistent problem in leprosy. Type 1 and type 2 (erythema nodosum leprosum-ENL) reactions are the major causes of nerve damage and permanent disabilities. Diagnosing lepra reactions correctly is important for timely institution of therapy to prevent and treat disability and morbidity. Aim and objectives<strong> </strong>of the study were<em> </em>to make detailed observations on clinical and histopathological features of type1 and type 2 lepra reactions.</p><p class="abstract"><strong>Methods:</strong> In this study we included 50 patients diagnosed during a 1-year period as lepra reactions based on clinic-histopathological corelation.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of the 50 patients, 4 were of type 1 reaction and 46 of type 2 reaction from which recurrence was more commonly seen with type 2 reactions. The most consistent histopathological findings in type1 reaction were periadnexal inflammatory infiltrates (100%) and lymphocytes in granuloma (100%), followed by papillary dermal edema and intercellular edema within granuloma (75%). Surprisingly, folliculotropism of and lymphocytic panniculitis was seen in 50% cases. In ENL, the most common histological findings were periadnexal inflammatory infiltrates (95.6%), presence of neutrophils within the granuloma (86.9%), foamy macrophages followed by papillary dermal edema (69.5%), and neutrophilic panniculitis (43.4%). Vasculitis like changes was noted in only 46% cases.</p><p class="abstract"><strong>Conclusions:</strong> Infiltration of macrophage granulomas by neutrophils is a reliable sign of ENL. Classical signs of vasculitis are not always present in ENL. Folliculotropism and lymphocytic panniculitis are frequent in type1 reactions while neutrophilic panniculitis is common with ENL.</p>


2022 ◽  
Vol 15 (1) ◽  
pp. e245174
Author(s):  
Rohith George ◽  
Sydney D'Souza ◽  
Ibrahim Masoodi

Being a region endemic for leprosy, clinical practitioners in India often encounter myriad manifestations and diverse complications of the disease. However, the masking of the obvious clinical presentations due to the coexistence of a closely resembling unrelated disorder, a ‘mimicker’, would indeed pose a serious diagnostic predicament unless a high degree of clinical suspicion is maintained. Leprosy, also known as Hansen’s disease is a chronic infectious disease caused by Mycobacterium leprae complex that involves the skin and peripheral nerves. Neurofibromatosis type 1 (NF1) also known as von Recklinghausen’s disease is an autosomal dominant genetic disorder that presents with skin changes and benign peripheral nerve sheath tumours called neurofibromas. Here, we present the case of a 35-year-old man with NF1 who presented with type 2 lepra reaction (erythema nodosum leprosum, ENL) and the skin biopsy unmasked ENL nodule among the group of NF1 nodules.


1970 ◽  
Vol 10 (1) ◽  
pp. 31-33
Author(s):  
Zannatun Nur ◽  
Fazle Rabbi Mohammed ◽  
Monzurul H Chowdhury ◽  
Md Ziaus Shams ◽  
Md Billal Alam ◽  
...  

Leprosy could be best understood as two conjoined diseases. The first is a chronic mycobacterial infection that elicits an extraordinary range of cellular immune responses. The second is lepra reaction, whose course and sequelae often extend many years beyond the cure of the infection and may have severely debilitating physical, social, and psychological consequences. Type-2 lepra reaction is also termed Erythema nodosum leprosum (ENL) regardless of the site of involvement, which is in turn a Coomb and Gell Type III hypersensitivity reaction. The paradox of ENL is that it can be a life-threatening disorder and requires control with immunosuppression which may itself pose life-threatening risks for patients Indian studies found its prevalence rate of almost 50% in those with LL and 9% in BL cases and the mean time to presentation with ENL was 3.7 months after starting multi-drug therapy (MDT). Hitherto we report a severe and steroid dependent case of chronic ulcerated ENL, not only occurred sixteen years after successful treatment of lepromatous leprosy, but also had an unusual initial presentation of arthritis. To the best of our knowledge, ENL for such a prolonged period of 15 years was not reported earlier.  doi:10.3329/jom.v10i1.2002J Medicine 2009; 10: 31-33


2019 ◽  
Vol 7 (3) ◽  
pp. 388-391
Author(s):  
Smilja Tudzarova-Gjorgova ◽  
Sandra Gjorgova-Gjeorgjievski ◽  
Boro Ilievski

BACKGROUND: In 1882, the German pathologist Friedrich Daniel von Recklinghausen described a series of patients with a combination of cutaneous lesions and tumours of the peripheral and central nervous system. Succeeding this paper, all of the patients with similar symptoms were given the diagnosis “von Recklinghausen disease”. In the 20th century, a distinction was made between Neurofibromatosis type 1 (NF1) and Neurofibromatosis type 2 (NF2) with the help of molecular testing. CASE REPORT: We are presenting the results from multiple surgical esthetic and reconstructive surgical procedures performed on a female patient with severe congenital neurofibromatosis during 15 years (2000-2015). The external appearance of our patient was not reflected in the general public’s beauty standards. Convinced that she was unusual and unaccepted by the society, she gathered all of the strength and became our patient at 15 years of age. CONCLUSION: Transforming the patient’s life in the next fifteen years improved her overall health and her life quality.


2012 ◽  
Vol 19 (3) ◽  
pp. 285-290
Author(s):  
Denisa Kovacs ◽  
Luiza Demian ◽  
Aurel Babeş

Abstract Objectives: The aim of the study was to calculate the prevalence rates and risk ofappearance of cutaneous lesions in diabetic patients with both type-1 and type-2diabetes. Material and Method: 384 patients were analysed, of which 47 had type-1diabetes (T1DM), 140 had type-2 diabetes (T2DM) and 197 were non-diabeticcontrols. Results: The prevalence of the skin lesions considered markers of diabeteswas 57.75% in diabetics, in comparison to 8.12% in non-diabetics (p<0.01). The riskof skin lesion appearance is over 7 times higher in diabetic patients than in nondiabetics.In type-1 diabetes the prevalence of skin lesions was significantly higherthan in type-2 diabetes, and the risk of skin lesion appearance is almost 1.5 timeshigher in type-1 diabetes than type-2 diabetes compared to non-diabetic controls.Conclusions: The diabetic patients are more susceptible than non-diabetics todevelop specific skin diseases. Patients with type-1 diabetes are more affected.


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