Tuberculous Lymphadenopathy in a Case of Erythema Nodosum Leprosum

Abstract

Erythema nodosum leprosum (ENL) is a debilitating inflammatory complication of leprosy characterised by inflammatory cutaneous nodule with or without ulceration. An intriguing feature of ENL is its exquisite sensitivity to treatment with the immunomodulatory drug thalidomide, which was discovered serendipitously in the early 1960s. Thalidomide is now the treatment of choice for ENL. However, being an immunosuppressant, thalidomide has the potential of making the patient vulnerable to infections. 1 Tuberculosis (TB) and leprosy are two ancient pathogens, which have been identified as infecting humans since thousands of years. It has been shown from archaeological evidence, post-mortem findings, and retrospective analysis of leprosy institutions' data that there is a highly observed incidence of concomitant infection with leprosy and TB. However, reports of concomitant infection in modern literature remain scarce. Estimation of the annual new case detection rate (ANCDR) in India where both TB (ANCDR 181 per 100,000 in 2011). 2 and leprosy (ANCDR 10.35 per 100,000 in 2011). 3 remain endemic, suggest that only 0.019 cases of concomitant infection per 100,000 population are detected per year. CASE SUMMARYA 30-year-old male was admitted in the Department of Medicine, Assam Medical College and Hospital in September 2015 with complaints of multiple painful swellings over armpits and groins for 20 days along with fever. He had received MDT for leprosy the previous year and was currently on corticosteroids and thalidomide for recurrent ENL reaction. FNAC of the swollen lymph nodes proved them to be of tuberculous origin. The patient was put on ATT under DOTS and he improved eventually.