Type 2 leprosy reaction with Sweet's syndrome-like presentation

Abstract

Leprosy is a chronic disease characterized by manifestations in the peripheral nerves and skin. The course of the disease may be interrupted by acute phenomena called reactions. This article reports a peculiar case of type 2 leprosy reaction with Sweet's syndrome-like features as the first clinical manifestation of leprosy, resulting in a delay in the diagnosis due to unusual clinical presentation. The patient had clinical and histopathological features reminiscent of Sweet's syndrome associated with clusters of vacuolated histiocytes containing acid-fast bacilli isolated or forming globi. Herein, it is discussed how to recognize type 2 leprosy reaction with Sweet's syndrome features, the differential diagnosis with type 1 leprosy reaction and the treatment options. When this kind of reaction is the first clinical presentation of leprosy, the correct diagnosis might be not suspected clinically, and established only with histopathologic evaluation.

Bullous Erythema Nodosum as Initial Manifestation of Leprosy

“…It is essential to rule out bullous drug eruptions, Sweet's syndrome [8][9][10] , pemphigus vulgaris, bullous pemphigoid and other syndromes 11,12 .…”

“…It is characterized by systemic manifestations like arthralgia, fever, iridocyclitis, nephritis, myositis and lymphadenitis associated with eruption of numerous disseminated painful nodules characterized by erythema nodosum (EN) 1,2 . Although EN is considered the typical lesion of T2R, it may mimic diverse other clinical conditions, and in such cases, delays in diagnosis are commonly observed [3][4][5][6][7][8][9][10] . Bullous Erythema Nodosum Leprosum (BENL) is a subset of EN wich is a subset of EN which is manifested as disseminated bullous reactions.…”

“…Bullous Erythema Nodosum Leprosum (BENL) is a subset of EN wich is a subset of EN which is manifested as disseminated bullous reactions. This manifestation is very rare, with only a few cases reporting such disease spectrum 3,[7][8][9][10][11][12][13][14] .…”

A 13-Year-Old with Coexistence of Gastric Volvulus and Leprosy: A Case Report of Two Rare Entities

“…Leprosy, also known as Hansen's disease, is a chronic infectious disease caused by the acid-fast bacillus (AFB) Mycobacterium leprae [1]. It is rare in the United States (US), with less than 200 new cases per year [2].…”

“…On an extensive literature review, we found no reported cases of leprosy presenting with gastric distension, splenomegaly, or gastric volvulus [1, 6–17]. …”