Erythema leprosum – after treatment of Lepromatous Leprosy

Abstract

Leprosy is usually well-controlled by multidrug therapy (MDT). However, in case of noncompliance or leprosy reactions, it may present a therapeutically challenge. A 33-year-old Brazilian woman with lepromatous leprosy was treated with MDT for one year, but then discontinued therapy because she wanted to have children. Eight weeks after stopping her medications, she developed a severe and recalcitrant erythema (nodosum) leprosum (ENL) which presented histologically with thrombosed small veins and neutrophilic inflammation in fat septa, but without arteritis. During her pregnancy and ensuing lactation period, glucocorticoids were the only suitable drug. With the use of the shortened WHO/MDT regimen (one year vs. two years of treatment), ENL will probably be seen more often after the end of leprosy therapy. It needs to be rapidly recognized and treated to avoid damage to eyes or kidneys.

Leishmaniasis as a Manifestation of Immune Reconstitution Inflammatory Syndrome (IRIS) in HIV-Infected Patients

“…Leprosy is the prototype of granulomatous disease in which the immune response can result in a paradoxical exacerbation of a patient’s lesions, which are typically characterized as erythema nodosum leprosum. 34 Treatment with anti-inflammatory immunomodulatory drugs, such as thalidomide, is required to control the exacerbation of leprosy. 35,36 Further studies should be conducted to evaluate the effectiveness of combined ART and corticosteroid therapy during the first 6 months of treatment in HIV-infected individuals with severe immunosuppression, who are at potential risk for life-threatening immune restoration disease.…”

Prediction of the Occurrence of Leprosy Reactions Based on Bayesian Networks

“…The three features that exerted the highest impact upon the performance of the system were the R&J classi cation, histological index, and the combined effect of the genetic markers (Figure 2). The R&J class is a well-accepted major risk factor for the occurrence of reversal reactions [9,14,22,23,37,40,41].…”

“…Leprosy T2R mainly affects patients classi ed within the BB-LL range [14,37]. Patients presenting bacterial index higher than 4+ in skin smears are at increased risk for T2R [38,39].…”

Granulomatous dermatitis in a 29‐year‐old man from Bangladesh

“…Nevertheless, the presence of mycobacteria in the biopsy was suggestive of a multibacillary form based on the WHO classification. Thus, multi-drug therapy (MDT) (according to WHO) was initiated, which included rifampicin (600 mg once a month), dapsone (100 mg daily), and clofazimine (300 mg once a month and 50 mg daily) [1]. Furthermore, the patient received gabapentin (300 mg TID) for his neuropathic pain.…”