March 29 2024 12:08
Navigation
Users Online
bullet.gif Guests Online: 1

bullet.gif Members Online: 0

bullet.gif Total Members: 304
bullet.gif Newest Member: ruthbrown
Latest Articles
bullet.gif New Pediatric Stroke...
bullet.gif EM Talks on MP3
bullet.gif Ethical & Legal Aspe...
bullet.gif Advanced Trauma Life...
bullet.gif Snakes of Medical Im...
Host
NEPI website developed, maintained & supported by EmergencyMedicine.in
Articles Hierarchy
Articles Home » Cases and patients » Dermatology at a glance 1
Dermatology at a glance 1
bullet.gif 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:


Skin rash 1


Skin rash 2




What is your diagnosis?

(Answer is below)


5




4




3




2




1




0




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.


Britton WJ, Lockwood DN. Leprosy. Lancet 2004; 363(9416):1209-19.


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.

Comments
No Comments have been Posted.
Post Comment
Please Login to Post a Comment.
Ratings
Rating is available to Members only.

Please login to vote.

No Ratings have been Posted.
Login
Username

Password



Forgotten your password?
Request a new one here.
Want to join a discussion?
Starting/Replying to a discussion thread in NEPI Forum
Copyright © 2006-2020 EmergencyMedicine.in All Rights Reserved