DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20191766

Clinical and histopathological features in lepra reaction: a study of 50 cases

Urvi H. Shah, Monal M. Jadwani, Sahana P. Raju, Pranav H. Ladani, Neela V. Bhuptani

Abstract


Background: Lepra reactions remain a major persistent problem in leprosy. Type 1 and type 2 (erythema nodosum leprosum-ENL) reactions are the major causes of nerve damage and permanent disabilities. Diagnosing lepra reactions correctly is important for timely institution of therapy to prevent and treat disability and morbidity. Aim and objectives of the study were to make detailed observations on clinical and histopathological features of type1 and type 2 lepra reactions.

Methods: In this study we included 50 patients diagnosed during a 1-year period as lepra reactions based on clinic-histopathological corelation.

Results: Out of the 50 patients, 4 were of type 1 reaction and 46 of type 2 reaction from which recurrence was more commonly seen with type 2 reactions. The most consistent histopathological findings in type1 reaction were periadnexal inflammatory infiltrates (100%) and lymphocytes in granuloma (100%), followed by papillary dermal edema and intercellular edema within granuloma (75%). Surprisingly, folliculotropism of and lymphocytic panniculitis was seen in 50% cases. In ENL, the most common histological findings were periadnexal inflammatory infiltrates (95.6%), presence of neutrophils within the granuloma (86.9%), foamy macrophages followed by papillary dermal edema (69.5%), and neutrophilic panniculitis (43.4%). Vasculitis like changes was noted in only 46% cases.

Conclusions: Infiltration of macrophage granulomas by neutrophils is a reliable sign of ENL. Classical signs of vasculitis are not always present in ENL. Folliculotropism and lymphocytic panniculitis are frequent in type1 reactions while neutrophilic panniculitis is common with ENL.


Keywords


Erythema nodosum leprosum, Lepra reaction, Type 1 reaction

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References


Scollard DM, Smith T, Bhoopat L, Theetranont C, Rangdaeng S, Morens DM. Epidemiologic characteristics of leprosy reactions. Int J Lepr Other Mycobact Dis. 1994;62:559-67.

Van Brakel WH, Nicholls PG, Das L, Barkataki P, Suneetha SK, Jadhav RS, et al. The INFIR Cohort Study: Investigating prediction, detection and pathogenesis of neuropathy and reactions in leprosy. Methods and baseline results of a cohort of multibacillary leprosy patients in north India. Lepr Rev. 2005;76:14-34.

Prasad PVS, Kaviarasan PK. Classification, Clinical Features and Differential Diagnosis. In: IADVL Textbook of Dermatology. Fourth ed. vol III, New York, CRC Press; 2015: 3104.

Diana NJ. Lockwood, leprosy. In: Rooks textbook of dermatology. Ninth ed. vol I, John Wiley & Sons; 2016: 28.

Pocaterra L, Jain S, Reddy R, Muzaffarullah S, Torres O, Suneetha S, et al. Clinical course of erythema nodosum leprosum: An 11-year cohort study in Hyderabad, India. Am J Trop Med Hyg. 2006;74:868-79.

Naafs B. Leprosy reactions. New knowledge. Trop Geogr Med. 1994;46:80-4.

Richardus JH, Finlay KM, Croft RP, Smith WC. Nerve function impairment in leprosy at diagnosis and at completion of MDT:A retrospective cohort study of 786 patients in Bangladesh. Lepr Rev. 1996;67:297-305.

Pearson JM, Ross WF. Nerve involvement in leprosy: Pathology, differential diagnosis and principles of management. Lepr Rev. 1975;46:199-212.

Pandhi D, Chhabra N. New insights in the pathogenesis of type 1 and type 2 lepra reaction. Indian J Dermatol Venereol Leprol. 2013;79:739-49.

Ridley DS. The pathogenesis of leprosy and related diseases 1st ed. London :Wright; 1988.

Lockwood DN, Lucas SB, Desikan KV, EbenezarG, Suneetha S, Nicholls P. The histological diagnosis of leprosy type 1 reactions: Identification of key variables and an analysis of the process of histological diagnosis. J Clin Pathol. 2008;61:595-600.

Prasannan R, George M, Binitha MP, Lekha T. Clinical and histopathological study of lepra reactions from a tertiary care center in South India. Int J Res Dermatol. 2017;3:512-6.

Kumar B, Dogra S, Kaur I. Epidemiological characteristics of Leprosy reactions :15 years experience from North India. Int J Leprosy Other Mycobact Dis. 2004;72:125-33.

Sharma D, Joshi A, Kumar P. Stigma and Psychological Problems Encountered By People with Leprosy and How Counselling Helps: A Systematic Review. Int J Indian Psychol. 2017;4(4).

Adhe V, Dongre A, Khopkar U. A retrospective analysis of histopathology of 64 cases of lepra reactions. Indian J Dermatol. 2012;57:114-7.

Sarita S, Muhammed K, Najeeba R, Rajan G, Anza K, Binitha M, Aparna G. A study on histological features of lepra reactions in patients attending the Dermatology Department of the Government Medical College, Calicut, Kerala, India. Lepr Rev. 2013;84:51–64.