Nerve abscess in Hansen's disease as part of immune reconstitution inflammatory syndrome: a case report.

Immune reconstitution inflammatory syndrome is an inflammatory reaction in HIV-infected patients after initiation of antiretroviral therapy resulting from restored immunity to specific infectious or non-infectious antigens. A 36-year-old male patient on highly active antiretroviral therapy of six months duration, presented with reddish, tender lesions over medial aspect of arm and a single, anaesthetic patch. Tender fluctuant swellings were seen on the medial aspect of left forearm. A few of them had ruptured spontaneously discharging pus. A skin biopsy from the anaesthetic patch showed caseating epitheloid granulomas. A diagnosis of Hansen's disease borderline tuberculoid in type 1 reversal reaction, with formation of nerve abscess due to Immune Reconstitution Inflammatory Syndrome was made. The patient was started on multibacillary multidrug therapy as per WHO guidelines and highly active antiretroviral therapy was continued.

Topical phenytoin for wound healing.

Oral phenytoin is used widely for the treatment of convulsive disorders and about half the patients treated develop gingival overgrowth as a side effect. The apparent stimulatory effect has prompted its assessment in wound healing. Studies have shown topical phenytoin to promote healing of decubitus ulcers, venous stasis ulcers, diabetic ulcers, traumatic wounds, burns, and leprosy trophic ulcers. The mechanism of action has been postulated to be multifactorial. The present literature indicates that topical phenytoin deserves further investigation as a wound-healing agent in controlled dose-finding clinical trials.

Rifampicin and isoniazid in the treatment of leprous nerve abscesses.

Thirty nine cases of borderline tuberculoid leprosy having nerve abscesses (15 with sinuses) were treated with daily dose of rifampicin and isoniazid for six months along with standard multidrug therapy. The patients were followed up for three to five years. No recurrence of abscess or sinus was observed. Observations indicate that medical approach is required at times to supplement surgical intervention for management of these cases.

Ulnar nerve abscess in a multibacillary patient during post-multidrug therapy surveillance.

An old borderline-lepromatous leprosy patient, treated initially with DDS monotherapy followed by MDT, 11 years later during surveillance presented with 3-month-old asymptomatic cystic swelling, arising from the right ulnar nerve without exhibiting any evidence to document relapse of the disease. It responded promptly to corticosteroid therapy. This unusual clinical presentations of ulnar nerve abscess has not been reported elsewhere.

Multiple cold abscesses in a borderline lepromatous patient on multidrug therapy.

A 25-year-old male patient was diagnosed as a case of borderline lepromatous (BL) type of leprosy in erythema nodosum leprosum type reaction. He was put on multidrug treatment. He took regular treatment. Approximately a year after the beginning of the treatment he developed multiple cold abscesses and later tuberculosis of the left hip joint. He was given antitubercular treatment with 4 drugs and the abscesses were treated surgically. He showed good response. This unusual case and the role of intermittent rifampicin is discussed.