Unusual non-trophic ulcerations in leprosy: A case series of 17 patients

2021 ◽  
pp. 004947552199849
Author(s):  
Prakriti Shukla ◽  
Kiran Preet Malhotra ◽  
Parul Verma ◽  
Swastika Suvirya ◽  
Abir Saraswat ◽  
...  
Keyword(s):  
Erythema Nodosum ◽  
Case Series ◽  
Lepromatous Leprosy ◽  
Sweet Syndrome ◽  
Erythema Nodosum Leprosum ◽  
Leprosy Patients ◽  
Atypical Presentations ◽  
Neuropathic Ulcers

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.

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
Keyword(s):  
Case Report ◽  
Erythema Nodosum ◽  
Immunological Response ◽  
Lepromatous Leprosy ◽  
Multidrug Therapy ◽  
Cutaneous Lesions ◽  
Erythema Nodosum Leprosum

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.

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 Clinical and histopathological features in lepra reaction: a study of 50 cases

2019 ◽  
Vol 5 (2) ◽  
pp. 382
Author(s):  
Urvi H. Shah ◽  
Monal M. Jadwani ◽  
Sahana P. Raju ◽  
Pranav H. Ladani ◽  
Neela V. Bhuptani
Keyword(s):  
Erythema Nodosum ◽  
Histological Findings ◽  
Persistent Problem ◽  
Histopathological Features ◽  
Erythema Nodosum Leprosum ◽  
Inflammatory Infiltrates ◽  
Foamy Macrophages ◽  
Reliable Sign

<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>

Erythema nodosum leprosum (type 2 reaction) in a patient with neurofibromatosis type 1

2022 ◽  
Vol 15 (1) ◽  
pp. e245174
Author(s):  
Rohith George ◽  
Sydney D'Souza ◽  
Ibrahim Masoodi
Keyword(s):  
Neurofibromatosis Type 1 ◽  
Erythema Nodosum ◽  
Genetic Disorder ◽  
Neurofibromatosis Type ◽  
Skin Changes ◽  
Erythema Nodosum Leprosum ◽  
Clinical Presentations ◽  
High Degree

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.

scholarly journals Leprosy type 1 reactions and erythema nodosum leprosum

2008 ◽  
Vol 83 (1) ◽  
pp. 75-82 ◽  
Author(s):  
Indira P. Kahawita ◽  
Stephen L. Walker ◽  
Diana N.J. Lockwood
Keyword(s):  
Drug Therapy ◽  
Erythema Nodosum ◽  
Significant Proportion ◽  
Nerve Damage ◽  
Successful Completion ◽  
Leprosy Reactions ◽  
Erythema Nodosum Leprosum ◽  
Leprosy Patients

Leprosy reactions are a major cause of nerve damage and morbidity in a significant proportion of leprosy patients. Reactions are immunologically mediated and can occur even after successful completion of multi-drug therapy. This review focuses on the epidemiology, pathology and treatment of leprosy type 1 reactions, erythema nodosum leprosum and silent neuropathy.

scholarly journals Steroid Dependent Ulcerated Erythema Nodosum Leprosum 16 Years after Successful Treatment of Leprosy

1970 ◽  
Vol 10 (1) ◽  
pp. 31-33
Author(s):  
Zannatun Nur ◽  
Fazle Rabbi Mohammed ◽  
Monzurul H Chowdhury ◽  
Md Ziaus Shams ◽  
Md Billal Alam ◽  
...  
Keyword(s):  
Successful Treatment ◽  
Erythema Nodosum ◽  
Mycobacterial Infection ◽  
Lepromatous Leprosy ◽  
Psychological Consequences ◽  
Erythema Nodosum Leprosum ◽  
Steroid Dependent ◽  
Life Threatening ◽  
Cellular Immune

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

scholarly journals Dysregulation of IL-4 expression in lepromatous leprosy patients with and without erythema nodosum leprosum

2000 ◽  
Vol 71 ◽  
Author(s):  
I. NATH ◽  
N. VEMURI ◽  
A. L. REDDI ◽  
M. BHARADWAJ ◽  
P. BROOKS ◽  
...  
Keyword(s):  
Erythema Nodosum ◽  
Lepromatous Leprosy ◽  
Erythema Nodosum Leprosum ◽  
Leprosy Patients
Sign in / Sign up

Export Citation Format

Share Document