Severe Erythema Nodosum Leprosum in Lepromatous Leprosy Patient
Case Report
DOI:
https://doi.org/10.55175/cdk.v51i12.1116Keywords:
Erythema nodosum leprosum, leprosy, multi-drug therapyAbstract
A case of a 58-year-old woman with lepromatous leprosy and severe ENL reaction is reported. The patient has symptoms of pustules for 1 year and the nodules were getting worse in the last week, accompanied by fever, joint pain, nausea, and vomiting. Physical examination revealed madarosis, infiltrates of both ears, and multiple painful erythematous nodules on the extremities and trunk. Slit skin smear examination showed bacterial index +3 and morphological index of 15%. Histopathological examination revealed neutrophil infiltration and vasculitis in the upper dermis. The patient was diagnosed with lepromatous leprosy and severe ENL reaction. The patient received multidrug therapy and methylprednisolone (62.5 mg/day), which was gradually reduced. The ENL reaction is caused by the deposition of M. leprae antigens and antibodies in small blood vessels, resulting in vasculitis and the release of enzymes that damage tissues. ENL reactions are commonly found in multibacillary MH and occur before, during, and after treatment. This reaction is mediated by cytokines produced by T-helper-2 (Th2). ENL reactions can cause disability.
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References
Chavarro-Portillo B, Soto CY, Guerrero MI. Mycobacterium leprae’s evolution and environmental adaptation. Acta Trop. 2019;197:105041. DOI: 10.1016/j.actatropica.2019.105041.
Maymone MBC, Laughter M, Venkatesh S, Dacso MM, Rao PN, Stryjewska BM, et al. Leprosy: Clinical aspects and diagnostic techniques. J Am Acad Dermatol. 2020;83(1):1–14. DOI: 10.1016/j.jaad.2019.12.080.
Natasha J, Esti PK, Komarasari E, Rohmah B. Penggunaan pentoksifilin pada reaksi eritema nodosum leprosum berat dengan lesi vaskulonekrotik: Sebuah laporan kasus berbasis bukti. Media Dermato Venereol Indones. 2019;45(2):81–7. DOI: 10.33820/mdvi.v45i2.19.
Negera E, Walker SL, Bobosha K, Howe R, Aseffa A, Dockrell HM, et al. T-cell regulation in Erythema Nodosum Leprosum. PLoS Negl Trop Dis.2017;11(10):e0006001. DOI: 10.1371/journal.pntd.0006001.
Alberts CJ, Smith WCS, Meima A, Wang L, Richardus JH, Islands N, et al. Leprosy/Hansen disease: Management of reactions and prevention of disabilities. Vol. 5. Internat J Community Med Public Health [Internet]. 2019:1–72. Available from: http://ovidsp.ovid.com/ovidweb. cgi?T=JS&PAGE=reference&D=emed13&NEWS=N&AN=365909956.
Thangaraju P, Venkatesan S, Gurunthalingam M, Babu STT. Rationale use of thalidomide in erythema nodosum leprosum - A non-systematic critical analysis of published case reports. Rev Soc Bras Med Trop. 2020;53:e20190454. DOI: 10.1590/0037-8682-0454-2019.
Bhat RM, Vaidya TP. What is new in the pathogenesis and management of erythema nodosum leprosum. Indian Dermatol Online J. 2020;11(4):482–92.
de Souza Aarao TL, Esteves NR, Esteves N, de Miranda Soares LP, da Silva Pinto D, Fuzii HT, et al. Relationship between growth factors and its implication in the pathogenesis of leprosy. Microb Pathog. 2014;77:66–72. DOI: 10.1016/j.micpath.2014.10.005.
Gomes de Castro KK, Lopes da Silva PH, Nahar dos Santos L, Leal JMP, de Pinho Pereira MM, Alvim IMP, et al. Downmodulation of regulatory T cells producing TGF- participates in pathogenesis of leprosy reactions. Front Med (Lausanne). 2022;9:865330. DOI: 10.3389/fmed.2022.865330.
Polycarpou A, Walker SL, Lockwood DNJ. A systematic review of immunological studies of erythema nodosum leprosum. Front Immunol.2017;8:233. DOI: 10.3389/fimmu.2017.00233.
Fonseca AB de L, Simon M do V, Cazzaniga RA, de Moura TR, de Almeida RP, Duthie MS, et al. The influence of innate and adaptative immuneresponses on the differential clinical outcomes of leprosy. Infect Dis Poverty 2017;6(1):5. DOI: 10.1186/s40249-016-0229-3.
Chatterjee D, Saikia UN, Narang T, Dogra S. The diagnostic dilemma of erythema nodosum leprosum - a clinicohistological study. Lepr Rev.2017;88(2):217–26.
Bhat RM, Vaidya TP. What is new in the pathogenesis and management of erythema nodosum leprosum. Indian Dermatol Online J. 2020;11(4):482–92. DOI: 10.4103/idoj.IDOJ_561_19.
WHO. Guidelines for the diagnosis, treatment and prevention of leprosy. New Delhi: World Health Organization, Regi Office for South East Asia [Internet]. 2018. Available from: https://iris.who.int/bitstream/handle/10665/274127/9789290226383-eng.pdf?sequence=58.
Kumar B, Kar HK, Dogra S. IAL textbook of leprosy. Jaypee Brothers Med Publ.; 2023.
Negera E, Walker SL, Bobosha K, Bekele Y, Endale B, Tarekegn A, et al. The effects of prednisolone treatment on cytokine expression in patients with erythema nodosum leprosum reactions. Front Immunol. 2018;9:189. DOI: 10.3389/fimmu.2018.00189.
P K Mishra SR, Samal R, Behera B. Thalidomide and steroid in the management of erythema nodosum leprosum. Indian J Pharmacol. 2022;54(3):177–82. DOI: 10.4103/ijp.ijp_946_21.
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Copyright (c) 2024 Adelia Wuri Pramudita, Harijono Kariosentono, Annisa Marsha Evanti, Aiman Hilmi Asaduddin
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