title: Persistent reaction in paucibacillary leprosy: case reports.
abstract: Three patients of histopathologically confirmed borderline-tuberculoid leprosy showing no acid-fast bacilli and with lesions confined to the face, 2 on the cheek and 1 on the forehead, were given multidrug therapy as recommended by the WHO for paucibacillary cases. Within 3 months the lesions showed signs of upgrading (or reversal) reaction which was substantiated by histopathology. In 1 patient the facial nerve was affected leading to facial palsy. The lymphocyte transformation test did not show a significant rise. All 3 patients were given oral prednisolone for periods varying between 5 and 7 months, but the response was poor except in 1 patient in whom the facial palsy responded favourably. Injections of sodium antimony gluconate tried in 1 patient after stoppage of steroids did not control the reaction. After 18 months of regular follow-up during therapy, the cutaneous reaction in the patient with facial nerve involvement subsided leaving significant atrophy. However, in the other 2 patients the skin lesion persisted with clinical and histopathological evidence of upgrading reaction. The reasons for the unnatural persistence of reaction in these patients is not clear.
authors.affiliation: Institute of Pathology (ICMR), New Delhi.
authors.forename: U
authors.initials: U
authors.lastname: Saxena
authors.forename: V
authors.initials: V
authors.lastname: Ramesh
authors.forename: R S
authors.initials: RS
authors.lastname: Misra
authors.forename: A
authors.initials: A
authors.lastname: Mukherjee
mesh_terms: D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D015439:Leprosy, Borderline / Q000188:drug therapy / Q000473:pathology*; D015441:Leprosy, Tuberculoid / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000473:pathology*; D013997:Time Factors
chemical_list: D000893:Anti-Inflammatory Agents