Dermatology at a glance 1 Posted by webmaster
on June 20 2007
A 48-year old gentleman presented to the Emergency Department with history of painful swellings all over his body of 10 days duration.
He was on medication prescribed by a village hospital for his hypo-pigmented patch on his right forearm.
He complained of numbness over his right upper limb and left lower limb of 1 month duration.
Physical examination revealed well-defined maculo-papular, shiny, tender rash all over the body. Following are photographs of his lesions:
What is your diagnosis?
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Diagnosis: Lepra Reaction - Type 1
Lepra reaction is the immune response demonstrated by the patient who is initiated with treatment for leprosy. It is the hypersensitivity reaction due to antigens released by the dead and dying M.leprae.
This response is observed to occur in 2 patterns. Type 1 - manifests in the early stages of treatment as sudden progressive development of skin lesions, which are erythematous, shiny, raised and inflammed.
On the other hand, Type 2 reaction is synonymously referred to as ENL - Erythema Nodosum Leprosum and occurs later in the course of treatment. Signs and symptoms of ENL include localised neuritis, fever and joint pains. Lesions may appear on any area, including the palms and soles. They are erythematous, transient in occurrence and are often associated with orchitis, myositis, and iridocyclitis. Treatment for Lepra Reaction is mostly symptomatic. It is prudent to seek the early advice of a dermatologist, since these patients often require in-hospital admission.
This article was contributed by
Dr. Moses Kirubairaj and Prof. Suresh David, CMC Vellore 632 004
Bibliography
Gelber RH. Leprosy (Hansens disease). In: Kasper DL, Braunwald E, Fauci AS, Longo DL, Jamison LJ eds. Harrisons Principles of Internal Medicine16th edn. New York: Mc Graw Hill, 2004; 1: 966-72.
Agarwal V, Singh R , Chauhan S et al. Pitting oedema with arthritis as the presenting manifestation of type I Lepra reaction. J Indian Rheumatol Assoc 2004 : 12 : 123-6
Dixit VB. Diffuse lepromatosis with recurring ulcerative erythema nodosum leprosum. Indian J Lepr 1992; 64(1); 112-3.
