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>

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.

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.

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.

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.

Bullous erythema nodosum leprosum (bullous type 2 reaction)

2002 ◽  
Vol 41 (6) ◽  
pp. 362-364 ◽  
Author(s):  
Gomathy Sethuraman ◽  
Divakaran Jeevan ◽  
Chakravarthy Rangachary Srinivas ◽  
Gopal Ramu
Keyword(s):  
Erythema Nodosum ◽  
Erythema Nodosum Leprosum

scholarly journals Comparison of clinicopathologic parameters and oncologic outcomes between type 1 and type 2 papillary renal cell carcinoma

BMC Urology ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Xiang Le ◽  
Xiang-Bo Wang ◽  
Hao Zhao ◽  
Ren-Fu Chen ◽  
Peng Ge
Keyword(s):  
Renal Cell Carcinoma ◽  
Tumor Size ◽  
Renal Cell ◽  
Papillary Renal Cell Carcinoma ◽  
Oncologic Outcomes ◽  
Angiolymphatic Invasion ◽  
Clinicopathologic Parameters ◽  
Foamy Macrophages

Abstract Background To compare the clinicopathologic parameters and oncologic outcomes between type 1 and type 2 papillary renal cell carcinoma (PRCC). Methods This study was approved by the review board (NO.XYFY2019-KL032–01). Between 2007 and 2018, 52 consecutive patients who underwent surgery at a single tertiary referral hospital were included. Clinicopathologic and survival data were collected and entered into a database. The Kaplan-Meier method, and univariate and multivariate Cox proportional hazard regression analyses were performed to estimate progression-free survival (PFS) and cancer-specific survival (CSS). Results Of the 52 patients, 24 (46.2%) were diagnosed with type 1 PRCC, and 28 (53.8%) had type 2 PRCC. The mean tumor size was 4.8 ± 2.5 cm. The two subtypes displayed different morphological features: foamy macrophages were more common in type 1 PRCC, while eosinophils and microvascular angiolymphatic invasion were more frequent in type 2 PRCC. Type 2 cases showed higher tumor stage and World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade than type 1 cases (T3-T4: 43% vs 17%, P = 0.041; G3-G4: 43% vs 8%, P = 0.005). In univariate analysis, type 2 PRCC had a lower probability for PFS and CSS than patients with type 1 PRCC (P = 0.016, P = 0.049, log-rank test, respectively). In multivariate analysis, only WHO/ISUP grade (HR 11.289, 95% CI 2.303–55.329, P = 0.003) and tumor size (HR 1.244, 95% CI 1.034–1.496, P = 0.021) were significantly associated with PFS. Conclusions PRCC subtype displayed different morphological features: foamy macrophages, eosinophils and microvascular angiolymphatic invasion are pathologic features that may aid in the distinction of the two subtypes. Histologic subtype of PRCC is not an independent prognostic factor and only WHO/ISUP grade and tumor size were independent predictors for PFS.

Lepra reactions in new leprosy cases at diagnosis: a study of 50 Pakistani patients

2020 ◽  
pp. 1-14
Author(s):  
Rabia Ghafoor ◽  
Muhammad Irfan Anwar ◽  
Mutaher Zia ◽  
Admin
Keyword(s):  
Disease Transmission ◽  
Early Recognition ◽  
Initial Diagnosis ◽  
Female Ratio ◽  
Pakistani Population ◽  
Erythema Nodosum Leprosum ◽  
Male Female Ratio ◽  
Medical Histories

Abstract Objective: To determine the occurrence and characteristics of the two types of lepra reactions, in new leprosy cases at initial diagnosis, in a Pakistani population. Methods: This retrospective descriptive study was done at MALC Karachi .All new leprosy cases who were registered at MALC during a two-and-a-half year period were enrolled. Their medical records were checked and selected all cases who had presented with a lepra reaction, at initial diagnosis. A total of 50 such cases were identified. Data was then collected from their medical histories, physical examination records and laboratory investigation reports. Results: Out of the total 50 cases in this study, 2 (4%) were children and 48 (96%) were adults. Male-female ratio was 4.6:1. 30 (60%) cases presented with a type 1 reaction and 20 (40%) with type 2. 30 (60%) cases were classified as borderline lepromatous (BL). Among these 17 (57%) had a type 2 reaction. Inflamed plaques were the main feature, in 27 (90%) cases of type 1. Crops of painful, erythematous nodules were seen in 19/20; 95% cases of type 2. Ulnar nerves were the most commonly enlarged nerves, in those with type 1 (73%) and common peroneal in type 2 (65%). Conclusion: Lepra reactions can be a presenting feature in a significant number of new leprosy cases, at initial diagnosis. Early recognition and management of these reactions can help prevent disease transmission, lifelong  deformities and disabilities. Keywords: Leprosy, Lepra reactions, type 1 (reversal) reaction, type 2 erythema nodosum leprosum (ENL) reaction.

scholarly journals Pathogenesis of bullous erythema nodosum leprosum: a case report

2020 ◽  
Vol 8 (12) ◽  
pp. 4509
Author(s):  
Navdeep Kaur
Keyword(s):  
Case Report ◽  
Erythema Nodosum ◽  
Acute Onset ◽  
Acid Fast Bacilli ◽  
Smear Examination ◽  
Dermatological Examination ◽  
Erythema Nodosum Leprosum ◽  
Different Parts ◽  
Body Ache

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+.

scholarly journals BULLOUS ERYTHEMA NODOSUM AS INITIAL MANIFESTATION OF LEPROSY

2017 ◽  
Vol 5 (3) ◽  
pp. 116-119
Author(s):  
Carlos Antônio Gusmão Guerreiro Moura ◽  
Raphael Sampaio ◽  
Paulo Góes ◽  
Gabriel de Magalhães Freitas ◽  
Constança Margarida Sampaio Cruz ◽  
...  
Keyword(s):  
Erythema Nodosum ◽  
Mycobacterium Leprae ◽  
Initial Manifestation ◽  
Cell Mediated Immune Response ◽  
Assistant Physician ◽  
History Of ◽  
A Cell ◽  
Immunologic Reactions

Introduction: Leprosy is a chronic granulomatous infectious disease caused by Mycobacterium leprae with protean manifestations, particularly prone to affect skin and peripheral nerves. The natural course of the disease may be associated with the development of type 1 or type 2 immunologic reactions. These immunologic reactions are reported to be caused by increased activity of the immune system, particularly a cell-mediated immune response against live leprosy bacillus or remnants of dead bacilli. Leprosy is one of the oldest diseases of mankind. Its clinical diagnosis can be challenging due to the varied manifestations. The first description of bullous erythema nodosum was made 1898 and since then there are few recorded reports. Case Report: Here we present a case of bullous erythema nodosum as leprosy first manifestation. A 35 year-woman presented with 1-year history of disseminated blisters on trunk, forearms and thighs, and multiple painful ulcerated nodules on her face. She reported that the lesions in her face became eroded and ulcerated spontaneously. There were no thickened nerves. Blood and Histopathological investigations were made. The treatment instituted was prednisone 1mg/kg without thalidomide. After two weeks with excellent response, specific therapy for Mycobacterium leprae was initiated by the infectious diseases assistant physician with a satisfactory response.

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