Some unusual type 2 reactions in leprosy.
BACKGROUND
Type 2 reactions with lepromatous leprosy (LL) not occurring during multi-drug therapy (MDT) have been reported.


METHODS
Three patients have been described, each representing a prototype, the first presenting as bullous erythema nodosum leprosum (ENL), second with ENL erupting after treatment for co-existing pulmonary tuberculosis and resembling immune reconstitution inflammatory syndrome, and a third patient with recurrent Sweets-syndrome like presentation who had taken incomplete MDT in the past for leprosy. In all, the diagnosis was established by demonstration of acid-fast bacilli (AFB) on slit-skin smears (SSS) and histopathology.


CONCLUSIONS
The fact that reactions can occur in patients with clinically inapparent LL, who are more likely to present in general hospitals, has been reemphasized to enhance awareness among physicians. First presentation of leprosy as ENL is probably precipitated by common antibiotics taken for other illnesses. Since reactional episodes can occur before, during and after MDT for leprosy and the clinical picture is not specific to any of them, it is important to ascertain the status of anti-leprosy therapy during these episodes and treat them accordingly.
Ramesh
V
V
Department of Dermatology & STD, Safdarjang Hospital & Vardhman Mahavir Medical College, New Delhi, India. weramesh@hotmail.com
Pahwa
Manish
M
D000328:Adult; D001707:Biopsy, Needle; D004359:Drug Therapy, Combination; D004893:Erythema Nodosum / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D007194:India; D007917:Leprostatic Agents / Q000008:administration & dosage; D015440:Leprosy, Lepromatous / Q000175:diagnosis* / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D009166:Mycobacterium leprae / Q000187:drug effects / Q000276:immunology*; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D016463:Sweet Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D016896:Treatment Outcome
D007917:Leprostatic Agents