RESUMEN
Erythema nodosum leprosum (ENL) is an immune complex mediated type III hypersensitivity reaction seen in patients of borderline lepromatous and lepromatous leprosy. It can be caused by a wide array of triggers and can be seen before, during, or after completion of anti-leprosy therapy. There are multiple well-known triggers for type 2 reactions like the initiation of multidrug therapy, Mantoux testing, vaccination, mental and physical stress, and physiological states like pregnancy. Herein, we report a case of exacerbation of ENL in a middle-aged woman, probably due to COVID-19 vaccine while she was well-controlled on immunosuppressive therapy. The episode was treated with non-steroid anti-inflammatory drugs and oral steroids and the symptoms resolved within 2 weeks. Although causality was highly possible between the occurrence of ENL and COVID-19 vaccine, physicians should be aware that it can be easily managed with proper care and medicines and this should not be a basis for deferring the vaccine.
RESUMEN
Type 2 reactions may occur in the early stages of the anti-leprosy treatment, however, many cases may present 2–3 years after leprosy diagnosis. Some of such patients have been reported to develop episodes as late as 7 years after starting treatment. A 45 years old male, with a past history of intake of multi drug therapymultibacillary (MDT-MB) pack 15 years back presented with fever, generalized bodyache along with development of vesiculo-bullous lesions over the existing annular lesions of borderline lepromatous (BL) leprosy. Possibility of relapse was ruled out clinically as well as histopathologically and the patient was successfully treated with tapering doses of steroids as a case of severe type 2 reaction. Type 2 reaction is less commonly seen in BL leprosy as compared to lepromatous lepromatous (LL) leprosy. Moreover, development of vesiculo-bullous lesions in an annular pattern over existing lesions of BL leprosy as a manifestation of type 2 reaction has rarely been reported in literature. This case is even rarer as the patient is continuing to get type 2 reaction even after 15 years of completion of MDT-MB and that too in an annular pattern over the existing lesions.
RESUMEN
Lepra reaction is an acute exacervational status occurring in the chronic course of leprosy. Type 2 lepra reaction occur from multibacillus leprosy (such as BL or LL), which mediated by antigen-antibody immune complex deposited vasculitis, involving multiple organs, and usually associated with constitutional symptoms such as fever, malaise, joint pains. The skin lesions is characterized by painful and tender red papules or nodules on the skin, which also refers to erythema nodosum leprosum (ENL). Different rare atypical skin lesions of ENL have been reported such as bullous, ulcerative, necrotic, pustular, sweet syndrome like lesions in literature. The 74 years old male patient with lepromatous leprosy presented as multiple crusted ulcers on the trunk and red edematous nodule on extremities and face. The histopathologic feature was typical for type 2 lepra lesion. Fite stain revealed large histiocytes containing well defined dense granular bacillus. This case was very rare and interesting because of unusual crusted ulcerative skin lesions combined with conventional ENL lesions and leprosy itself is rare in Korea these days.