Rare atypical presentations in Type 2 lepra reaction: a case series. (18th October 2013)

• Record Type: Journal Article
• Authors: Vijendran, Pragasam; Verma, Rajesh; Vasudevan, Biju; Mitra, Debdeep; Badad, Ambresh; Neema, Shekhar
• Is Part Of: International journal of dermatology. Volume 53:Number 3(2014:Mar.)
• Page Start: 323
• Page End: 326
• Publication Date: 2013-10-18
• Subjects: Dermatology -- Periodicals; 616.5
• DOI: 10.1111/ijd.12292
• Languages: English
• ISSNs: 0011-9059

Abstract

<abstract abstract-type="main" id="ijd12292-abs-0001"> <title>Abstract</title> <sec id="ijd12292-sec-0001" sec-type="section"> <title>Objectives</title> <p>Type 2 lepra reaction is a Th2‐mediated type III hypersensitivity reaction in leprosy, with a characteristic cutaneous manifestation in the form of erythema nodosum leprosum (ENL). We describe unusual presentations of Type 2 lepra reaction in five patients.</p> </sec> <sec id="ijd12292-sec-0002" sec-type="section"> <title>Methods</title> <p>Patient data and dermatological findings were analyzed in three men and two women diagnosed with Hansen's disease.</p> </sec> <sec id="ijd12292-sec-0003" sec-type="section"> <title>Results</title> <p>Findings included multiple tender, polycyclic, necrotic lesions distributed over the face in one patient, and painful, fluid‐filled lesions on both arms and lower limbs in another. The third patient showed erythematous, tender nodules, bullae, and necrotic ulcers over the back and upper and lower limbs. The fourth showed erythematous tender nodules over the face, neck, back, and extremities, predominantly in sun‐exposed areas. The fifth revealed multiple erythematous, severely tender nodules and urticarial plaques mimicking those of Sweet's syndrome. Diagnosis of borderline or lepromatous leprosy with atypical Type 2 reaction were made in all cases.</p> </sec> <sec id="ijd12292-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Type 2 lepra reactions are antigen antibody‐mediated immune complex reactions that present with constitutional symptoms and ENL characterized by tender, erythematous, evanescent nodules mainly on the face, arms, and legs. Over 50% of lepromatous leprosy patients and 25% of borderline lepromatous leprosy patients experienced type 2 lepra reactions prior to the advent of multi‐drug therapy. Thalidomide is the drug of choice for severe atypical lepra reactions because of its anti‐tumor necrosis factor‐α action. Awareness of these atypical variants and prompt diagnosis and treatment are essential to prevent mortality and morbidity in potentially treatable patients.</p> </sec> </abstract>