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Mehta N, Agarwal S, Khaitan BK, Gupta V. Paraphimosis as the only manifestation of type 2 lepra reaction. Int J Dermatol 2021; 61:e91-e93. [PMID: 34590724 DOI: 10.1111/ijd.15924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Nikhil Mehta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Binod K Khaitan
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Vishal Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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2
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Alakad R, Nofal A, Assaf M. Atypisches Erythema nodosum leprosum: Diagnostische und therapeutische Aspekte. J Dtsch Dermatol Ges 2021; 19:1133-1144. [PMID: 34390149 DOI: 10.1111/ddg.14449_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/28/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Rania Alakad
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Ägypten.,Member of Interactive Dermatology Foundation Research group
| | - Ahmad Nofal
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Ägypten.,Member of Interactive Dermatology Foundation Research group
| | - Magda Assaf
- Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Ägypten.,Member of Interactive Dermatology Foundation Research group
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Alakad R, Nofal A, Assaf M. Atypical presentations of erythema nodosum leprosum: Diagnostic and therapeutic aspects. J Dtsch Dermatol Ges 2021; 19:1133-1143. [PMID: 34033221 DOI: 10.1111/ddg.14449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/28/2021] [Indexed: 11/28/2022]
Abstract
Classic erythema nodosum leprosum (ENL) is characterized clinically by abrupt eruption of tender erythematous nodules, papules and plaques. Variable atypical patterns have been described, for example pustular, bullous, ulcerative, necrotic and Sweet's syndrome-like ENL. We aim to review previously reported cases of atypical ENL addressing the diagnostic and therapeutic aspects of these uncommon presentations. A search of medical literature for all cases of atypical ENL was conducted in the PubMed database till 2020. Data of patients with atypical ENL were collected and analyzed to describe the epidemiological, clinico-histological and therapeutic features. The major five clinically described presentations of atypical ENL include vesiculo-bullous lesions (46 % of patients), ulcero-necrotic lesions (41 %), erythema multiforme-like lesions (28 %), Sweet's syndrome-like lesions (11 %) and pustules (9 %). The skin lesions were accompanied by fever and constitutional symptoms in all patients. Oral steroids and thalidomide were the main lines of therapy in most of the reported patients. Dermatologists and pathologists should keep in mind the clinical variability of ENL to avoid misdiagnosis and delayed management. Early recognition can help control disease progression and save the patients from further complications.
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Affiliation(s)
- Rania Alakad
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Member of Interactive Dermatology Foundation Research group
| | - Ahmad Nofal
- Department of Dermatology, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Member of Interactive Dermatology Foundation Research group
| | - Magda Assaf
- Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.,Member of Interactive Dermatology Foundation Research group
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Indhumathi E, Dhanapriya J, Dineshkumar T, Sakthirajan R, Gopalakrishnan N. Hansen's disease with lepra reaction presenting with IgA dominant infection related glomerulonephritis. INDIAN J PATHOL MICR 2021; 63:289-291. [PMID: 32317536 DOI: 10.4103/ijpm.ijpm_654_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Various renal abnormalities in leprosy have been described largely in literature but the occurrence of IgA dominant infection related glomerulonephritis in leprosy with type 2 lepra reaction has not been reported so far. We present here a 60-year-old man with a history of leprosy in the past admitted with type 2 lepra reaction, rapidly progressive glomerulonephritis with severe renal failure requiring dialysis and diagnosed to have IgA dominant infection related glomerulonephritis.
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Affiliation(s)
- Elayaperumal Indhumathi
- Department of Nephrology, Institute of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - Jeyachandran Dhanapriya
- Department of Nephrology, Institute of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - Thanigachalam Dineshkumar
- Department of Nephrology, Institute of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - Ramanathan Sakthirajan
- Department of Nephrology, Institute of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
| | - Natarajan Gopalakrishnan
- Department of Nephrology, Institute of Nephrology, Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India
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Rathinam SR, Parikh JG, Rao NA. Ocular erythema nodosum leprosum: An immunohistochemical study. Indian J Ophthalmol 2020; 68:2028-2030. [PMID: 32823468 PMCID: PMC7690513 DOI: 10.4103/ijo.ijo_549_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Episcleritis, scleritis, and anterior uveitis are common clinical manifestations of ocular leprosy. Erythema nodosum leprosum (ENL) is an acute, exaggerated systemic immunological reaction that complicates the course of this chronic indolent disease. We present an ocular immunohistochemical study of severe form of ENL involving even the ciliary body and choroid resulting in the perforation of the globe on the initiation of anti leprosy therapy. We used CD-3, CD-68, S-100, and CD-20 for immunohistochemistry. It revealed plenty of CD-3-positive T-cells and CD-68-positive macrophages and a few S-100 and CD-20-positive cells. The inflammatory exudates stained positive for IgG and IgM. The diagnosis was ocular ENL.
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Affiliation(s)
- S R Rathinam
- Uveitis Service, Aravind Eye Hospital and PG Institute of Ophthalmology, Madurai, Tamil Nadu, India
| | | | - Narsing A Rao
- USC Department of Ophthalmology, Co.Director, USC Roski Eye Institute, Keck School of Medicine of USC, USA
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Narang I, Ailawadi P, Garg VK. Uncommon adverse effects of thalidomide: seldom reported phenomena in leprosy. LEPROSY REV 2020. [DOI: 10.47276/lr.91.2.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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7
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de Macedo CS, de Carvalho FM, Amaral JJ, de Mendonça Ochs S, Assis EF, Sarno EN, Bozza PT, Pessolani MCV. Leprosy and its reactional episodes: Serum levels and possible roles of omega-3 and omega-6-derived lipid mediators. Cytokine 2018; 112:87-94. [DOI: 10.1016/j.cyto.2018.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 01/27/2023]
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Pires CAA, Miranda MFRD, Bittencourt MDJS, Brito ACD, Xavier MB. Comparison between histopathologic features of leprosy in reaction lesions in HIV coinfected and non-coinfected patients. An Bras Dermatol 2015; 90:27-34. [PMID: 25672296 PMCID: PMC4323695 DOI: 10.1590/abd1806-4841.20153048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 02/03/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Leprosy and HIV are diseases that have a major impact on public health in Brazil.
Patients coinfected with both diseases, appear to be at higher risk to develop
leprosy reactions. OBJECTIVE The aim of this study is to describe the histopathological aspects of cutaneous
lesions during reactional states in a group of patients with HIV-leprosy
coinfection, compared to patients with leprosy, without coinfection. METHODS Two groups were established: group 1 comprised of 40 patients coinfected with
HIV-leprosy; group 2, comprised of 107 patients with leprosy only. Patients
presenting reactional states of leprosy had their lesions biopsied and
comparatively evaluated. RESULTS Reversal reaction was the most frequent feature in both groups, with dermis edema
as the most common histopathological finding. Giant cells were seen in all group 1
histopathological examinations. Dermis edema was the most common finding in
patients with erythema nodosum leprosum. CONCLUSION Few histopathological differences were found in both groups, with reversal
reaction as the most significant one, although this fact should be analyzed
considering the predominant BT clinical form in the coinfected group and BB form
in the group without HIV. Larger prospective studies in patients with HIV-leprosy
coinfection are needed to confirm and broaden these results.
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9
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Recognizing and managing the immunologic reactions in leprosy. J Am Acad Dermatol 2014; 71:795-803. [DOI: 10.1016/j.jaad.2014.03.034] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 03/14/2014] [Accepted: 03/18/2014] [Indexed: 11/18/2022]
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Bala S, Sen S, Chatterjee G, Gangopadhyay A. Atypical erythema nodosum leprosum as the presenting feature in multibacillary leprosy: a case report. Indian J Dermatol 2014; 59:94-5. [PMID: 24470672 PMCID: PMC3884940 DOI: 10.4103/0019-5154.123519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sanchaita Bala
- Department of Dermatology, IPGMER and SSKM Hospitals, Kolkata, India. E-mail:
| | - Sumit Sen
- Department of Dermatology, IPGMER and SSKM Hospitals, Kolkata, India. E-mail:
| | - Gobinda Chatterjee
- Department of Dermatology, IPGMER and SSKM Hospitals, Kolkata, India. E-mail:
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Vijendran P, Verma R, Vasudevan B, Mitra D, Badad A, Neema S. Rare atypical presentations in Type 2 lepra reaction: a case series. Int J Dermatol 2013; 53:323-6. [DOI: 10.1111/ijd.12292] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Rajesh Verma
- Department of Dermatology; Command Hospital; Pune India
| | | | - Debdeep Mitra
- Department of Dermatology; Armed Forces Medical College; Pune India
| | - Ambresh Badad
- Department of Dermatology; Armed Forces Medical College; Pune India
| | - Shekhar Neema
- Department of Dermatology; Armed Forces Medical College; Pune India
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12
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Leprosy with ANA positive mistaken for connective tissue disease. Clin Rheumatol 2013; 32:645-8. [DOI: 10.1007/s10067-013-2163-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 11/15/2012] [Accepted: 12/31/2012] [Indexed: 11/26/2022]
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13
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Vashisht D, Das AL. Bullous erythema nodosum leprosum. Med J Armed Forces India 2012; 69:71-3. [PMID: 24532940 DOI: 10.1016/j.mjafi.2012.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 02/03/2012] [Indexed: 10/28/2022] Open
Affiliation(s)
- Deepak Vashisht
- Graded Specialist (Derm & Ven), 92 Base Hospital, C/o 56 APO, India
| | - A L Das
- Ex Prof & Head, Dept of Dermatology, AFMC, Pune 40, India
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Aggarwal R, Gupta O, Beg S, Prasad R. Erythema nodosum leprosum: report of two cases. Diagn Cytopathol 2011; 41:366-8. [PMID: 21932352 DOI: 10.1002/dc.21785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 06/22/2011] [Indexed: 11/09/2022]
Abstract
Erythema nodosum leprosum (ENL) or type 2 lepra reaction is an inflammatory reaction, which may occur in the course of hanseniasis, may compel the patient to seek medical attention and may result in nerve function impairment and subsequent disability. Thus, recognition and timely management of these patients is critical in order to avoid permanent disability. Fine-needle aspiration cytology is simple and effective tool that aids in the correct diagnosis and management of ENL. Herein, we present two cases of ENL, one with typical and another with atypical presentation.
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Affiliation(s)
- Roopak Aggarwal
- Department of Pathology, VMMC and Safdarjung Hospital, Safdarjung, New Delhi, India
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Guditi S, Ram R, Ismal K, Sahay M, Dakshinamurthy K, Girish N, Prasad N. Leprosy in a renal transplant recipient: review of the literature. Transpl Infect Dis 2009; 11:557-62. [DOI: 10.1111/j.1399-3062.2009.00428.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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17
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Affiliation(s)
- Tamihiro Kawakami
- Department of Dermatology, St. Marianna University School of Medicine, Kawasaki, Japan.
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Sunderkötter CH, Tomimori-Yamashita J, Nix V, Maeda SM, Sindrilaru A, Mariano M, Sorg C, Roth J. High expression of myeloid-related proteins 8 and 14 characterizes an inflammatorily active but ineffective response of macrophages during leprosy. Immunology 2004; 111:472-80. [PMID: 15056385 PMCID: PMC1782447 DOI: 10.1111/j.0019-2805.2004.01836.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Macrophages are decisive cells for the course of leprosy as they phagocytose Mycobacterium leprae and have the potential to influence the specific immune response. Expression and release of the myeloid-related protein (MRP) 8 and MRP14 (S100A8 and S100A9) characterize a proinflammatory subtype of macrophage that is prominent in, for example, murine infection with lack of a T helper 1 cell response and in certain highly active chronic inflammations of mice and humans. We investigated cutaneous biopsies of the different forms of leprosy (41 untreated patients) including leprosy reaction type 1 (reversal reaction) and type 2 (erythema nodosum leprosum) (n = 18) for expression of MRP8 and MRP14 by subtypes of macrophages. Concomitantly we determined serum levels of MRP8 and MRP14 by sandwich enzyme-linked immunosorbent assay. Expression of MRP8 and MRP14 by CD68-positive macrophages was low in tuberculoid leprosy and rose significantly in borderline tuberculoid leprosy and especially in multibacillary forms, there being expressed by mycobacteria-loaded foam cells. A significant rise of MRP8 and MRP14 expression also occurred in lepra reactions compared to the corresponding non-reactional forms. In type 2 reactions this additional increase was associated with a significant elevation of serum levels. In type 1 it was associated with expression of MRP8 and MRP14 by epitheloid and giant cells, which so far were considered not to express both proteins. In conclusion, we present evidence that the two prominent proteins MRP8 and MRP14 can be re-expressed in vivo by tissue macrophages in chronic infection, that their increased expression is characteristic for a macrophage subtype associated with high inflammatory but low antimycobacterial activity in the absence of a T helper 1 response, and that their significant rise in serum during erythema nodosum leprosum bears diagnostic and pathophysiological relevance.
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Affiliation(s)
- Cord H Sunderkötter
- Institute of Experimental Dermatology, University of Münster, Münster, Germany.
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Abstract
The thalidomide product is a racemic mixture of the L- and D-enantiomeric forms of a synthetic glutamic acid derivative that contains a phthalimide ring and a glutarimide ring. Initially marketed as a sedative, it was withdrawan from the world market after it was found to be associated with severe birth defects. Recently, the compound has generated renewed interest because of its immunomodulatory and anti-angiogenic properties. The nature of its immunologic effects is under active investigation. It is orally bioavailable and can be administered in once daily dosing. Its primary route of metabolism is spontaneous hydrolysis. In controlled clinical trials, thalidomide has proven effective in the treatment of erythema nodosum leprosum, oral and oesophageal aphthous ulceration associated with advanced HIV infection and oral ulceration associated with Behcet's syndrome. Promising results have been obtained in preliminary studies of other immunologic and neoplastic disorders, but controlled clinical studies are still lacking for these entities. Adverse effects include teratogenicity, peripheral neuropathy and sedation. In the US, thalidomide can be prescribed only through a restricted drug distribution program.
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Affiliation(s)
- J M Jacobson
- Department of Medicine, Mount Sinai Medical School, Box 1009-1 Gustave Levy Place, New York, NY 10029, USA.
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