Erythema nodosum leprosum in a general hospital

Rea, T. H.

doi:10.1001/archderm.111.12.1575

Cited by 17 publications

(11 citation statements)

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“…This has been borne out by our study, where its incidence was 20% among leprosy patients. This is in agreement with similar reports from India (3,8) and elsewhere (9)(10)(11). Predominance of males in our study and a male:female ratio of 6:1 appears to be a feature unique to our country and is in tune with the reporting of patients in the hospital in general.…”

Section: Discussionsupporting

confidence: 94%

Reactions in Leprosy

Sehgal

Sharma

1988

The Journal of Dermatology

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The clinical manifestations of types I (lepra) and II (ENL) reactions are now well‐appreciated. The correlation of clinical expression to bacterial index, lepromin response and histological features has hardly been attempted. In a study of 35 reaction patients, 18 type I (lepra) and 17 type II (ENL), the preceding parameters were studied in detail. Their incidence among leprosy patients was 20%. Males in the age group 20–30 years were frequently affected, the ratio of males to females being 6:1. The mean age at onset in type II (ENL) was younger than in type I (lepra) reactions. However, the duration of the reactions was variable. They were frequently precipitated by antileprosy drugs. The clinical features were cardinal. The bacteriological features reflected wide variations, but were considered imperative. Early Fernandez and Late Mitsuda reactions were useful adjuvants for monitoring progress. The utility of changing microscopic pathology in determining the swing towards the lepromatous or tuberculoid end of leprosy spectrum are emphasized.

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Section: Discussionsupporting

confidence: 94%

Reactions in Leprosy

Sehgal

Sharma

1988

The Journal of Dermatology

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“…Twenty-two (69%) patients had lepra type 2 reaction in this series. 17 In present study, 50% (n = 22) of patients had arthritis at presentation, 14 (32%) presenting with acute onset persisting arthritis involving large and small joints mimicking RA. Oligoarticular involvement like spondyloarthropathy was seen in seven patients (16%).…”

Section: Discussionmentioning

confidence: 47%

Leprosy revealed in a rheumatology clinic: A case series

et al. 2012

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“…This patient recalled having multiple asymptomatic skin lesions for two years but did not seek specialist opinion. Erythema nodosum leprosum reactions may occur spontaneously in longstanding lepromatous leprosy, 2 but for it to simulate Sweet’s syndrome is much less common, though it was reported as early as 1987 by Kuo and Chan 3 . In the patient described, the clinical and histopathological features were consistent with both lepromatous leprosy and Sweet’s syndrome.…”

Section: Discussionmentioning

confidence: 75%

Lepromatous leprosy in erythema nodosum leprosum reaction mimicking Sweet’s syndrome

et al. 2011

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A 52-year-old Malay man presented with an acute one week history of multiple erythematous papules and nodules on the limbs, trunk, and face. On physical examination, he had multiple erythematous nontender, nonpruritic nodules and plaques on the trunk, limbs, and forehead ( Fig. 1). A few nodules showed pustulation and ulceration ( Fig. 2). He was febrile at 38°C. Systemic review and general examination were normal. There were no thickened nerves, neurological deficits, or deformities of the hands or feet. Eyes and oral mucosa were normal.The initial clinical impression was that of Sweet's syndrome in view of the acute onset of typical lesions and fever. Complete blood count revealed marked leukocytosis (24.1 · 10 3 /ll) with predominant neutrophilia (87.5%). Erythrocyte sedimentation rate (ESR) was markedly raised. Differential diagnoses included cutaneous lymphoma and infective causes, such as cutaneous tuberculosis, multibacillary leprosy, and nontuberculous mycobacterial or subcutaneous fungal infection.Skin biopsy confirmed the diagnosis of lepromatous leprosy with erythema nodosum leprosum reaction. The histology showed a Grenz zone with granulomas throughout the dermis, consisting of foamy macrophages with globi of bacilli within. Focal areas showed thrombosed vessels with necrosis of vessel walls and numerous neutrophils. Fite stain was positive for leprae bacilli (Fig. 3). Direct immunofluorescence showed granular deposits of IgA and C3 in the upper and lower dermal blood vessel walls, consistent with vasculitis.Slit skin smear confirmed the presence of Mycobacterium leprae with a Bacteriological Index of 5+ and a Morphological Index of <1%. DiscussionLeprosy has been controlled in Singapore for many years. This has been achieved by a good program for control of Figure 1 Erythematous plaques and nodules on the trunk Figure 2 Erythematous plaque with pustule and healing ulcer

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Erythema nodosum leprosum in a general hospital

Cited by 17 publications

References 0 publications

Reactions in Leprosy

Reactions in Leprosy

Leprosy revealed in a rheumatology clinic: A case series

Lepromatous leprosy in erythema nodosum leprosum reaction mimicking Sweet’s syndrome

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