Liver lesions in reactional states in leprosy.

Liver biopsy was done in 21 adult patients of leprosy in acute reaction. They included 10 of lepromatous leprosy, seven of tuberculoid leprosy and four of dimorphic leprosy. Except for a single case of tuberculoid leprosy all showed granulomatous lesions of varying sizes and frequency, in the liver. The lesions appeared to be unique for reaction and immunologically-based. The sequence of events appeared to be: (1) Immunologically-mediated alteration of Kupffer cells with adhesion of lymphocytes and polymorphounuclear leucocytes (2) Small granulomas of proliferating Kupffer cells, lymphocytes and polymorphs. (3) In some cases. formation of larger granulomas with breaking down of reticulin and liver cell necrosis.

Liver function in leprosy.

Thirty eight patients of leprosy were classified on the basis of clinical and biopsy findings into 10 lepromatous (all reactional), 20 tuberculoid (7 in reaction) and 8 dimorphic (5 in reaction). The liver function tests--serum proteins, albumin/globulin ratio, fractions in paper electrophoresis, serum glutamic pyruvic transaminase (SGPT) and thymol turbidity tests--and the serum cholesterol was estimated in each patient. The abnormalities were a reversal of the albumin/globulin ratio in all the three groups and an increase in beta/globulin fraction in the lepromatous group, but total proteins were within normal limits. The thymol turbidity test showed moderately elevated levels in all three groups. SGPT was slightly raised in a few cases. Only a single patient with tuberculoid leprosy showed serum cholesterol to be over 250 mg per 100 ml.