title: Complex Type 2 Reactions in Three Patients with Hansen's Disease from a Southern United States Clinic.
abstract: In non-endemic countries, leprosy, or Hansen's disease (HD), remains rare and is often underrecognized. Consequently, the literature is currently lacking in clinical descriptions of leprosy complications in the United States. Immune-mediated inflammatory states known as reactions are common complications of HD. Type 1 reactions are typical of borderline cases and occur in 30% of patients and present as swelling and inflammation of existing skin lesions, neuritis, and nerve dysfunction. Type 2 reactions are systemic events that occur at the lepromatous end of the disease spectrum, and typical symptoms include fever, arthralgias, neuritis, and classic painful erythematous skin nodules known as erythema nodosum leprosum. We report three patients with lepromatous leprosy seen at a U.S. HD clinic with complicated type 2 reactions. The differences in presentations and clinical courses highlight the complexity of the disease and the need for increased awareness of unique manifestations of lepromatous leprosy in non-endemic areas.
authors: Emory University, Atlanta, Georgia; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors: Kristoffer E
authors: KE
authors: Leon
authors: Emory University, Atlanta, Georgia; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors: Jorge L
authors: JL
authors: Salinas
authors: Emory University, Atlanta, Georgia; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors: Robert W
authors: RW
authors: McDonald
authors: Emory University, Atlanta, Georgia; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors: Anandi N
authors: AN
authors: Sheth
authors: Emory University, Atlanta, Georgia; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia jessica.fairley@emory.edu.
authors: Jessica K
authors: JK
authors: Fairley
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001210:Asia, Southeastern / Q000208:ethnology; D001459:Bangladesh / Q000208:ethnology; D004893:Erythema Nodosum / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D006967:Hypersensitivity / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D007917:Leprostatic Agents / Q000627:therapeutic use*; D015440:Leprosy, Lepromatous / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D009443:Neuritis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D011241:Prednisone / Q000627:therapeutic use; D013792:Thalidomide / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D007917:Leprostatic Agents; D013792:Thalidomide; D011241:Prednisone