RESUMEN
Lucio leprosy is a diffuse non-nodular form of lepromatous leprosy. Lucio phenomenon is a type of reactional state which occurs in untreated cases due to the bacillary invasion of endothelial cells. We hereby describe a histopathologically confirmed case of Lucio leprosy with Lucio phenomenon. The patient presented with pleomorphic clinical features and started taking antileprosy treatment and systemic steroids. After few days of admission, she developed deep ulcers exposing the fascia. She also developed cardiogenic shock secondary to septicaemia. She was managed with inotropes and broad-spectrum antibiotics. The patient was given appropriate wound care and the ulcers healed within a period of 3 months and antileprosy drugs were continued. Our patient is a de novo case of Lucio leprosy with Lucio phenomenon and pleomorphic clinical features who developed near fatal septic shock. She was managed successfully. Despite the extensive disease manifestation, all the wounds healed completely.
Asunto(s)
Lepra Lepromatosa , Choque Séptico , Humanos , Femenino , Lepra Lepromatosa/tratamiento farmacológico , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/diagnóstico , Choque Séptico/etiología , Leprostáticos/uso terapéutico , Antibacterianos/uso terapéutico , Choque Cardiogénico/etiología , Persona de Mediana EdadRESUMEN
Leprosy is a chronic infectious disease caused by the bacillus Mycobacterium leprae. The disease may evolve for inflammatory reactions, reversal reaction (RR) and erythema nodosum leprosum (ENL), the major cause of irreversible neuropathy in leprosy, which occur in 1 in 3 people with leprosy, even with effective treatment of M. leprae. Leprosy remains persistently endemic in our region where it predominantly affects lowest socioeconomic conditions people, as Toxoplasma gondii infection in the municipality studied. Previously, we have shown T. gondii coinfection as a risk marker for leprosy, mainly in its severe form. This present study assessed whether T. gondii infection is also a risk factor for leprosy reactions and the predictive value of immunoglobulin production prior to development of leprosy reactions. Patients with leprosy (n = 180), co-infected or not with T. gondii, had their serum investigated for levels of IgA, IgE, IgG1, IgG2, IgG3 and IgG4 anti-PGL-1 by ELISA prior to development of leprosy reactions. The serologic prevalence for T. gondii infection was 87.7% in leprosy reaction patients reaching 90.9% in those with ENL. The leprosy reaction risk increased in T. gondii seropositive individuals was two-fold ([OR] = 2.366; 95% confidence interval [CI 95%]: 1.024-5.469) higher than those seronegative, and considering the risk of ENL, this increase was even more evident (OR = 6.753; 95% CI: 1.050-72.85) in coinfected individuals. When evaluated the prediction of anti-PGL-1 immunoglobulin levels for development of leprosy reactions in patients coinfected or not with T. gondii, only the increase IgE levels were associated to occurrence of reactional episodes of leprosy, specifically ENL type, in patients coinfected with T. gondii, compared to those not coinfected or no reaction. Thus, the immunomodulation in co-parasitism T. gondii-M. leprae suggest increased levels of IgE as a biomarker for early detection of these acute inflammatory episodes and thereby help prevent permanent neuropathy and disability in leprosy patients.
Asunto(s)
Eritema Nudoso , Inmunoglobulina E , Toxoplasma , Toxoplasmosis , Humanos , Toxoplasmosis/sangre , Toxoplasmosis/complicaciones , Toxoplasmosis/inmunología , Toxoplasmosis/epidemiología , Eritema Nudoso/inmunología , Eritema Nudoso/epidemiología , Eritema Nudoso/sangre , Femenino , Masculino , Adulto , Inmunoglobulina E/sangre , Persona de Mediana Edad , Toxoplasma/inmunología , Coinfección/inmunología , Coinfección/parasitología , Mycobacterium leprae/inmunología , Adulto Joven , Adolescente , Factores de Riesgo , Anciano , Lepra Lepromatosa/inmunología , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/sangre , Lepra Lepromatosa/epidemiologíaRESUMEN
Tropical diseases prevalent in leprosy-endemic areas may alter the immunological patient response and also complicate the presentation of leprosy reactional episodes. The introduction of anti-malarial drugs in our case produced a subsidence of reaction. With dwindling manpower skilled in leprosy, the reactional episodes are very often treated with non-steroidal anti-inflammatory drugs, steroids and thalidomide, neglecting the possibility of other co-existing infections, tropical or other. Our case emphasises the importance of history, examination and balanced investigation in the context of tropical diseases in endemic areas before injudicious intervention.
Asunto(s)
Eritema Nudoso , Lepra Lepromatosa , Lepra , Humanos , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/tratamiento farmacológico , Plasmodium falciparum , Eritema Nudoso/complicaciones , Eritema Nudoso/tratamiento farmacológico , Talidomida/uso terapéutico , Lepra/complicacionesRESUMEN
BACKGROUND: Erythema nodosum leprosum (ENL) is an immunologically mediated phenomenon complicating the course of leprosy. Reverse Koebner phenomenon is the term used to describe the sparing of previously injured or diseased skin by new skin lesions of the disease. METHODS: A middle-aged woman with a known case of lepromatous leprosy for the past year presented with an eruption of reddish painful nodules over her body. The lesions were found to characteristically spare the sites of previous scars. RESULTS: This sparing phenomenon of previous scar sites has been termed reverse Koebner phenomenon, a site of the body that offers greater resistance than the rest of the body to the onset of the disease, seen in various diseases, but it has never been described in ENL. CONCLUSION: This sparing of scar sites in ENL can be attributed to reverse Koebner phenomenon.
Asunto(s)
Eritema Nudoso , Hipersensibilidad , Lepra Lepromatosa , Lepra , Humanos , Persona de Mediana Edad , Femenino , Cicatriz/complicaciones , Cicatriz/patología , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/tratamiento farmacológico , Lepra Lepromatosa/patología , Piel/patología , Lepra/complicaciones , Hipersensibilidad/complicaciones , Hipersensibilidad/patologíaRESUMEN
Erythema nodosum leprosum (ENL) is an immunological complication of leprosy seen in 50% of lepromatous and 10% of borderline lepromatous leprosy. It usually presents as a multisystem disease with papulo-nodular skin lesions and fever. Arthralgia or arthritis is a common initial presentation of erythema nodosum leprosum. Pure rheumatologic presentation of lepromatous leprosy complicated by erythema nodosum leprosum is extremely rare, mimics connective tissue disease and is treated with steroids.
Asunto(s)
Enfermedades del Tejido Conjuntivo , Eritema Nudoso , Lepra Lepromatosa , Lepra Multibacilar , Lepra , Humanos , Eritema Nudoso/diagnóstico , Eritema Nudoso/tratamiento farmacológico , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/tratamiento farmacológicoRESUMEN
The coinfection of leprosy and tuberculosis has been rarely reported in literature. A middle-aged man who was a known case of hepatitis B infection had presented with ichthyosis with claw hand deformity and submandibular swelling, which were diagnosed with lepromatous leprosy and scrofuloderma, respectively.
Asunto(s)
Lepra Lepromatosa , Lepra , Tuberculosis Cutánea , Masculino , Persona de Mediana Edad , Humanos , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/diagnóstico , Tuberculosis Cutánea/diagnóstico , Tuberculosis Cutánea/tratamiento farmacológicoRESUMEN
Leprosy is a chronic infection caused by Mycobacterium leprae and Mycobacterium lepromatosis that preferentially compromises peripheral nerve, skin, and mucous membranes. Colombia achieved the goal of leprosy elimination in 1997. However, in Urabá (Colombia), there has been an increase in leprosy cases beginning in 2020. This case report shows a leprosy relapse 5 decades after the initial infection debuted as a necrotizing erythema nodosum leprosum. Therefore, long-term follow-up of patients with risk factors for relapse is emphasized, especially those treated before the standard of multidrug therapy (dapsone, clofazimine, and rifampin). This case report stresses the importance the importance of clinical follow-up and surveillance of patients with these events of interest for the public health.
Asunto(s)
Eritema Nudoso , Lepra Lepromatosa , Lepra , Humanos , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/tratamiento farmacológico , Eritema Nudoso/diagnóstico , Eritema Nudoso/tratamiento farmacológico , Leprostáticos/uso terapéutico , Quimioterapia Combinada , Lepra/tratamiento farmacológico , RecurrenciaAsunto(s)
Amiloidosis , Eritema Nudoso , Hipersensibilidad , Lepra Lepromatosa , Lepra Multibacilar , Síndrome Nefrótico , Paniculitis , Humanos , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/tratamiento farmacológico , Eritema Nudoso/complicaciones , Eritema Nudoso/diagnóstico , Síndrome Nefrótico/complicaciones , Lepra Multibacilar/complicaciones , Hipersensibilidad/complicaciones , Amiloidosis/complicaciones , Amiloidosis/diagnósticoRESUMEN
INTRODUCTION: Leprosy reactions (LRs) are inflammatory responses observed in 30%-50% of people with leprosy. First-line treatment is glucocorticoids (GCs), often administered at high doses with prolonged courses, resulting in high morbi-mortality. Methotrexate (MTX) is an immunomodulating agent used to treat inflammatory diseases and has an excellent safety profile and worldwide availability. In this study, we describe the efficacy, GCs-sparing effect and safety of MTX in LRs. METHODS: We conducted a retrospective multicentric study in France consisting of leprosy patients receiving MTX for a reversal reaction (RR) and/or erythema nodosum leprosum (ENL) since 2016. The primary endpoint was the rate of good response (GR) defined as the complete disappearance of inflammatory cutaneous or neurological symptoms without recurrence during MTX treatment. The secondary endpoint was the GCs-sparing effect, safety and clinical relapse after MTX discontinuation. RESULTS: Our study included 13 patients with LRs (8 men, 5 women): 6 had ENL and 7 had RR. All patients had had at least one previous course of GCs and 2 previous treatment lines before starting MTX. Overall, 8/13 (61.5%) patients had GR, allowing for GCs-sparing and even GCs withdrawal in 6/11 (54.5%). No severe adverse effects were observed. Relapse after MTX discontinuation was substantial (42%): the median relapse time was 5.5 months (range 3-14) after stopping treatment. CONCLUSION: MTX seems to be an effective alternative treatment in LRs, allowing for GCs-sparing with a good safety profile. Furthermore, early introduction during LRs may lead to a better therapeutic response. However, its efficacy seems to suggest prolonged therapy to prevent recurrence.
Asunto(s)
Eritema Nudoso , Lepra Lepromatosa , Lepra , Masculino , Humanos , Femenino , Metotrexato/uso terapéutico , Estudios Retrospectivos , Eritema Nudoso/tratamiento farmacológico , Eritema Nudoso/complicaciones , Lepra/tratamiento farmacológico , Lepra Lepromatosa/complicaciones , Glucocorticoides , RecurrenciaRESUMEN
Conventionally, leprosy has been divided into various spectra of presentation ranging from the tuberculoid to the lepromatous pole, as well as histoid, pure neuritic leprosy and reactional states. This however is an oversimplification as leprosy can present in unusual clinical forms that may obfuscate the diagnosis. Our objective was to highlight unusual clinical presentations of leprosy occurring across all spectra of the disease. Our case series describes eight uncommon presentations of leprosy seen over a period of 10 y from 2011 to 2021, wherein clinical diagnosis followed by a histopathological confirmation of leprosy was performed. These include rare presentations such as psoriasiform plaques, Lazarine leprosy, verrucous plaques and hypertrophic scarring. Many of these rare presentations remain hitherto unreported, such as primary hypogonadism and annular plaques mimicking erythema annulare centrifugum and erythema gyratum repens. Sarcoidosis and syphilis have been labeled as great mimickers in dermatology. The current case series and review is an attempt to highlight a multitude of unusual presentations of leprosy that need a separate mention to make a correct and timely diagnosis and prevent the debilitating sequelae of this otherwise treatable infectious disease.
Asunto(s)
Lepra Lepromatosa , Lepra , Enfermedades Cutáneas Genéticas , Sífilis , Humanos , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/patología , Lepra/complicaciones , Lepra/diagnóstico , EritemaRESUMEN
BACKGROUND: The lepromatous pole is a stigmatising prototype for patients with leprosy. Generally, these patients have little or no symptoms of peripheral nerve involvement at the time of their diagnosis. However, signs of advanced peripheral neuropathy would be visible during the initial neurological evaluation and could worsen during and after multidrug therapy (MDT). Disabilities caused by peripheral nerve injuries greatly affect these patients' lives, and the pathophysiological mechanisms underlying nerve damage remain unclear. OBJECTIVES: To evaluate the outcome of peripheral neuropathy in patients with lepromatous leprosy (LL) and persistent neuropathic symptoms years after completing MDT. METHODS: We evaluated the medical records of 14 patients with LL who underwent nerve biopsies due to worsening neuropathy at least four years after MDT. FINDINGS: Neuropathic pain developed in 64.3% of the patients, and a neurological examination showed that most patients had alterations in the medium- and large-caliber fibers at the beginning of treatment. Neurological symptoms and signs deteriorated despite complete MDT and prednisone or thalidomide use for years. Nerve conduction studies showed that sensory nerves were the most affected. MAIN CONCLUSIONS: Patients with LL can develop progressive peripheral neuropathy, which continues to develop even when they are on long-term anti-inflammatory and immunosuppressive therapy.
Asunto(s)
Lepra Lepromatosa , Lepra , Enfermedades del Sistema Nervioso Periférico , Humanos , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/tratamiento farmacológico , Lepra Lepromatosa/patología , Quimioterapia Combinada , Leprostáticos/efectos adversos , Lepra/patología , Enfermedades del Sistema Nervioso Periférico/etiologíaRESUMEN
Leprosy, a chronic infectious disease, and psoriasis, an inflammatory disorder, are distinct entities. Epidemiology data show that these two diseases are almost mutually exclusive, with only a few reported cases of their coexistence. Here, we present the case of a patient manifesting intermingled psoriatic and leprosy lesions diagnosed as borderline lepromatous leprosy and plaque psoriasis. Of note, Mycobacterium leprae bacilli were detected not only in the two types of lesions but also in normal-appearing skin and blood.
Asunto(s)
Lepra Lepromatosa , Psoriasis , Humanos , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/diagnóstico , Mycobacterium leprae/aislamiento & purificación , Psoriasis/complicaciones , Psoriasis/diagnóstico , CoinfecciónRESUMEN
BACKGROUND: Corticosteroids remain the main therapy in erythema nodosum leprosum (ENL), and long-term usage in chronic or recurrent ENL is a cause of significant morbidity and mortality. Thalidomide exerts dramatic effect in controlling ENL and helps reduce the dose of steroids, but the cost is a hindrance to its usage. METHODS: Patients of ENL (steroid naïve and steroid-dependent) were recruited over a 1-year period. An escalating dose of low-dose thalidomide with a reducing dose of prednisolone was titrated depending on the control of disease activity. The primary aim was to reduce the dose of steroids to the lowest effective dose, and the secondary aim was to stop. RESULTS: Sixteen patients of ENL were studied (mean duration of ENL 22.1 months, 15 severe ENL), and a majority (11/16, 68%) were on steroids with a mean duration of 11.27 months. All patients had steroid-related side effects (cushingoid habitus 81.8%, weight gain 54.5%, diabetes mellitus 9%, hyperlipidemia 18.18%, cataract 18.1%, osteoporosis 36.3%, striae 36.3%, acneiform eruptions 18.1%, and myopathy 9%). Steroids could be tapered in a majority of patients (n = 9) within 3 months (mean 2.44 months) with a low dose of thalidomide (25-150 mg/day, mean 78.3 mg) achieving a significant reduction in prednisolone dose (33.16 mg at baseline; 4.28 mg at 3 months, P < 0.05). Steroids could be stopped in 92% of patients by 3.03 months, and both drugs could be stopped in 80% of cases by 5.83 months. CONCLUSION: The rapid and effective control of ENL with low-dose thalidomide in our series is comparable to the historical efficacy of high-dose thalidomide regimens, making it an affordable therapy in resource-constrained settings and an excellent steroid-sparing agent. The rapid onset of disease control is likely attributable to its action via neutrophils.
Asunto(s)
Eritema Nudoso , Lepra Lepromatosa , Lepra Multibacilar , Paniculitis , Enfermedades Vasculares , Humanos , Eritema Nudoso/tratamiento farmacológico , Eritema Nudoso/inducido químicamente , Talidomida/uso terapéutico , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/tratamiento farmacológico , Leprostáticos/efectos adversos , Lepra Multibacilar/complicaciones , Prednisolona/uso terapéutico , Paniculitis/tratamiento farmacológico , Enfermedades Vasculares/complicacionesAsunto(s)
Coriorretinopatía Serosa Central , Lepra Lepromatosa , Humanos , Coriorretinopatía Serosa Central/complicaciones , Coriorretinopatía Serosa Central/diagnóstico , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/tratamiento farmacológico , Tomografía de Coherencia ÓpticaRESUMEN
Leprosy was eliminated globally in 2000, but it continues to be endemic in developing countries like India, Brazil and Indonesia, with a prevalence of 0.57/10 000 persons in India (2020). At the end of the year 2020, the prevalence was 129 389, and oral manifestation of the leprosy is luncommon. We hereby report a case of a female patient in her late 30s who presented with palatal perforation. Following a thorough history taking and full body clinical examination, we arrived at a diagnosis of leprosy, and prompt treatment was initiated. Knowledge of cases like this becomes important as the oral lesion is said to form an essential source of leprosy dissemination in the community, and awareness about them becomes crucial, demanding immediate attention.
Asunto(s)
Lepra Dimorfa , Lepra Lepromatosa , Lepra Multibacilar , Lepra , Femenino , Humanos , India/epidemiología , Lepra/diagnóstico , Lepra Dimorfa/epidemiología , Lepra Dimorfa/patología , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/tratamiento farmacológico , PrevalenciaRESUMEN
Resumen: Introducción: la enfermedad de Hansen es una enfermedad infecciosa crónica, causada por Mycobacterium leprae, que afecta principalmente piel y nervios periféricos. Las reacciones leprosas son eventos agudos que se asocian a un aumento de la morbimortalidad de la enfermedad. Objetivo: presentar el caso clínico de un paciente con fenómeno de Lucio, a través del cual se llegó al diagnóstico de enfermedad de Hansen, y remarcar la importancia de tener presente esta enfermedad, poco frecuente en nuestro país, para su correcto diagnóstico. Discusión: el fenómeno de Lucio es un tipo de reacción leprosa mediada por inmunocomplejos. Se caracteriza clínicamente por máculas o placas eritematovioláceas, de aparición súbita, que evolucionan a úlceras necróticas y curan dejando cicatrices estrelladas atróficas. De no mediar tratamiento, puede ser fatal, debido a sobreinfección y sepsis. Este se basa en el tratamiento específico de la infección, asociado a prednisona y un correcto manejo de las heridas.
Summary: Introduction: Hansen disease is a chronic infectious disease caused by Mycobacterium leprae, which mainly affects the skin and peripheral nerves. Leprosy reactions are acute events associated to an increase in the morbimortality of the disease. Objective: the study aims to present the clinical case of patient with Lucio´s phenomenon, which allowed the diagnosis of Hansen disease, and to emphasize on the importance of having this disease in mind for an appropriate diagnosis, despite it being rather unusual in our country. Discussion: Lucio´s phenomenon is a kind of leprosy reaction mediated by immune complexes. Clinically, it is characterized by the sudden onset of macules or blue hemorrhagic plaques, with a rapid evolution to necrotic ulcers, and it heals leaving star-shaped atrophic scars. If it is not treated, it may be fatal due to superinfection and sepsis. Treatment is based on specific medication for the infection, associated to prednisone and the correct handling of injuries.
Resumo: Introdução: a hanseníase é uma doença infecciosa crônica causada pelo Mycobacterium leprae, que acomete principalmente pele e nervos periféricos. As reações hansênicas são eventos agudos que estão associados ao aumento da morbimortalidade da doença. Objetivo: apresentar o caso de um paciente com fenômeno de Lúcio, por meio do qual se chegou ao diagnóstico de hanseníase, e ressaltar a importância de se ter em mente esta doença, rara em nosso meio, para seu correto diagnóstico. Discussão: o fenômeno de Lúcio é um tipo de reação hansênica mediada por imunocomplexos. Caracteriza-se clinicamente por máculas ou placas eritêmato-violáceas de início súbito que evoluem para úlceras necróticas e cicatrizam, deixando cicatrizes estreladas atróficas. Sem tratamento pode ser fatal, devido a superinfecção e sepse; a terapia está baseada no tratamento específico da infecção, associado à prednisona e no manejo correto da ferida.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Lepra Lepromatosa/complicaciones , Lepra/complicacionesRESUMEN
BACKGROUND: The numbers of circulating regulatory T cells (Tregs) are increased in lepromatous leprosy (LL) but reduced in erythema nodosum leprosum (ENL), the inflammatory complication of LL. It is unclear whether the suppressive function of Tregs is intact in both these conditions. METHODS: A longitudinal study recruited participants at ALERT Hospital, Ethiopia. Peripheral blood samples were obtained before and after 24 weeks of prednisolone treatment for ENL and multidrug therapy (MDT) for participants with LL. We evaluated the suppressive function of Tregs in the peripheral blood mononuclear cells (PBMCs) of participants with LL and ENL by analysis of TNFα, IFNγ and IL-10 responses to Mycobacterium leprae (M. leprae) stimulation before and after depletion of CD25+ cells. RESULTS: 30 LL participants with ENL and 30 LL participants without ENL were recruited. The depletion of CD25+ cells from PBMCs was associated with enhanced TNFα and IFNγ responses to M. leprae stimulation before and after 24 weeks treatment of LL with MDT and of ENL with prednisolone. The addition of autologous CD25+ cells to CD25+ depleted PBMCs abolished these responses. In both non-reactional LL and ENL groups mitogen (PHA)-induced TNFα and IFNγ responses were not affected by depletion of CD25+ cells either before or after treatment. Depleting CD25+ cells did not affect the IL-10 response to M. leprae before and after 24 weeks of MDT in participants with LL. However, depletion of CD25+ cells was associated with an enhanced IL-10 response on stimulation with M. leprae in untreated participants with ENL and reduced IL-10 responses in treated individuals with ENL. The enhanced IL-10 in untreated ENL and the reduced IL-10 response in prednisolone treated individuals with ENL was abolished by addition of autologous CD25+ cells. CONCLUSION: The findings support the hypothesis that the impaired cell-mediated immune response in individuals with LL is M. leprae antigen specific and the unresponsiveness can be reversed by depleting CD25+ cells. Our results suggest that the suppressive function of Tregs in ENL is intact despite ENL being associated with reduced numbers of Tregs. The lack of difference in IL-10 response in control PBMCs and CD25+ depleted PBMCs in individuals with LL and the increased IL-10 response following the depletion of CD25+ cells in individuals with untreated ENL suggest that the mechanism of immune regulation by Tregs in leprosy appears independent of IL-10 or that other cells may be responsible for IL-10 production in leprosy. The present findings highlight mechanisms of T cell regulation in LL and ENL and provide insights into the control of peripheral immune tolerance, identifying Tregs as a potential therapeutic target.
Asunto(s)
Eritema Nudoso , Lepra Lepromatosa , Lepra , Antiinflamatorios/uso terapéutico , Quimioterapia Combinada , Humanos , Interleucina-10 , Leprostáticos/uso terapéutico , Lepra/tratamiento farmacológico , Lepra Lepromatosa/complicaciones , Leucocitos Mononucleares , Estudios Longitudinales , Mycobacterium leprae , Prednisolona/farmacología , Prednisolona/uso terapéutico , Linfocitos T Reguladores , Factor de Necrosis Tumoral alfaAsunto(s)
Eritema Nudoso , Lepra Lepromatosa , Lepra Multibacilar , Lepra , Paniculitis , Eritema Nudoso/diagnóstico , Eritema Nudoso/tratamiento farmacológico , Eritema Nudoso/etiología , Humanos , Lepra Lepromatosa/complicaciones , Lepra Lepromatosa/diagnóstico , Lepra Lepromatosa/tratamiento farmacológicoRESUMEN
Reactions in leprosy represent sudden shift in the immunological response and are seen in 11-25% of affected patients. It can be seen before, during or after the completion of multidrug therapy (MDT).1 Two types of reactions are recognized; Type 1 reaction (T1R), seen in borderline leprosy, affecting mainly skin and nerves; type 2 reaction (T2R) or erythema nodosum leprosum (ENL), seen in lepromatous leprosy, characterized by systemic features in addition to cutaneous lesions. Trophic ulcers and ulcerating ENL are well known entities while cutaneous ulceration in T1R is extremely rare; we describe an immune-competent woman with cutaneous ulceration as a presenting feature to highlight the need to recognize this entity at the earliest opportunity.