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 lesions in experimental lepromatoid leprosy of the armadillo. A histopathologic study.

A retrospective study of liver lesions was made in 13 armadillos infected intracutaneously with 10(7) M. leprae from the same inoculum, to evaluate the pathogenesis of the experimental disease. Survival times ranged from 13 to 55 months. In seven armadillos the liver lesions were markedly less severe than in six of these animals. The extent of the lesions was unrelated to the duration of the infection and was interpreted as reflecting individual differences in resistance. In contrast to man, leprosy bacilli were found in the liver cells of both groups of armadillos but to a lesser extent in those of the more resistant armadillos. The latter also had no obvious changes in the liver tissue except for round cell infiltration and prominent Kupffer's cells which contained M. leprae. These lesions can be compared to indeterminate leprosy in humans. The lesions in the more susceptible (lepromatoid) armadillos were initiated in Kupffer's cells. Later, large collections of bacillated macrophages infiltrated the liver lobules. The liver cells heavily loaded with M. leprae developed a pale granular cytoplasm which became foamy in the late lesions. In three of the lepromatoid livers, lesions compatible with erythema nodosum leprosum were seen.

Hepatic lesions in asymptomatic children of leprosy patients.

Forty-two asymptomatic children of leprosy patients were studied for possible hepatic lesions. Hepatic lesions were observed in 47% while acid-fast bacilli in the liver were found in 9.5%. The most frequent lesions encountered included granuloma in 9.5%, focal areas of necrosis in 14%, portal triaditis in 17%, and Kupffer cell hyperplasia in 33%. Occasionally more than one lesion was observed in a biopsy. No correlation with the occurrence of the various hepatic lesions could be made with a history of BCG vaccination or results of skin tests done with tuberculin and lepromin.